CMS/EIP Fiscal Report Center: 57
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 11.00 533.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 8.00 388.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 46 46.52 2256.00 48.50
Subtotal (Total Children Is Unduplicated) 61 65.52 3177.50 48.50
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 3.00 150.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 60 231.50 15714.22 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 58 271.50 18429.42 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 117 515.50 34992.14 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 3 7.50 99.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 19.00 9.50 0.50
Subtotal (Total Children Is Unduplicated) 163 1050.00 69502.92 66.19
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Total 1115.52 72680.42 65.15
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Number of Children (Unduplicated) With at Least One Service 191
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Center 57
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 4 6.50 402.46 402.46
H 0 0.00 0.00 0.00
T 4 24.50 329.20 329.20
486 1084.52 71948.76 37902.44
Other 0 0.00 0.00 0.00
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Total 494 1115.52 72680.42 38634.10