CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EXT
Payclass Filters:MED
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 3 3.00 225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.50 337.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 47.00 3525.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 9.00 675.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 14.00 1050.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 13.00 721.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 75.50 5662.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.00 436.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 12 12.00 582.00 48.50
Subtotal (Total Children Is Unduplicated) 104 196.50 13715.50 69.80
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 8.00 9304.12 1163.02
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 3.00 206.58 68.86
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 203 1222.25 61112.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 57 263.75 17771.59 67.38
OCCT-97530HM-OT SESSION BY OT ASST 4 8.50 461.72 54.32
PHY-97110-PT SESSION BY LICENSED PT 61 361.50 24538.62 67.88
PHY-97110HM-PT SESSION BY PT ASST 16 95.50 5187.56 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 112 754.75 51232.43 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 6.50 85.80 13.20
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 3 26.25 1312.50 50.00
Subtotal (Total Children Is Unduplicated) 285 2750.00 171213.42 62.26
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Total 2946.50 184928.92 62.76
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Number of Children (Unduplicated) With at Least One Service 323
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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 0 0.00 0.00 0.00
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
1220 2946.50 184928.92 0.00
Other 0 0.00 0.00 0.00
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Total 1220 2946.50 184928.92 0.00