CMS/EIP Fiscal Report Center: 54
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 3 4.00 300.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.50 262.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 0.81 39.66 48.96
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 11 15.31 994.66 64.97
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 1.50 75.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.25 62.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 11.00 550.00 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 18 42.20 2878.68 68.22
OCCT-97530HM-OT SESSION BY OT ASST 1 0.20 11.00 55.00
PHY-97110-PT SESSION BY LICENSED PT 10 22.47 1534.39 68.29
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 45.70 3039.72 66.51
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.75 40.74 54.32
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 186.00 130.20 0.70
Subtotal (Total Children Is Unduplicated) 46 313.07 8422.23 26.90
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Total 328.38 9416.89 28.68
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Number of Children (Unduplicated) With at Least One Service 53
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Center 54
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
99 328.38 9416.89 0.00
Other 0 0.00 0.00 0.00
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Total 99 328.38 9416.89 0.00