CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
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
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 2.50 138.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.50 300.00 66.67
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.50 75.00 50.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.00 450.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 19 25.50 1523.75 59.75
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.00 885.24 295.08
AUD-92633-AUD REHAB POSTLING HEARING LOSS 1 1.00 68.86 68.86
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 22.75 1137.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 30 116.50 7908.02 67.88
OCCT-97530HM-OT SESSION BY OT ASST 2 7.00 380.24 54.32
PHY-97110-PT SESSION BY LICENSED PT 31 133.75 9078.95 67.88
PHY-97110HM-PT SESSION BY PT ASST 6 13.75 746.90 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 171.00 11675.36 68.28
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 60.00 30.00 0.50
Subtotal (Total Children Is Unduplicated) 75 528.75 31911.07 60.35
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Total 554.25 33434.82 60.32
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Number of Children (Unduplicated) With at Least One Service 81
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Center 51
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 46 141.00 5078.01 5078.01
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
205 413.25 28356.81 0.00
Other 0 0.00 0.00 0.00
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Total 251 554.25 33434.82 5078.01