CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.00 450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.00 450.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 36.50 2737.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 38.00 2850.00 75.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 36 89.50 6633.00 74.11
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 54.90 54.90
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.00 50.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 114 619.75 42068.63 67.88
PHY-97110-PT SESSION BY LICENSED PT 124 613.75 41661.35 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 11.00 597.52 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 166 734.25 49840.89 67.88
Subtotal (Total Children Is Unduplicated) 275 1980.75 134273.29 67.79
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Total 2070.25 140906.29 68.06
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Number of Children (Unduplicated) With at Least One Service 301
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Center 09
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 24 12.25 817.97 1761.60
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1273 2058.00 140088.32 0.00
Other 0 0.00 0.00 0.00
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Total 1297 2070.25 140906.29 1761.60