CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.00 375.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 6.00 291.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 12 12.00 582.00 48.50
Subtotal (Total Children Is Unduplicated) 23 28.00 1504.50 53.73
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 38.00 9475.65 249.36
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 3.00 90.00 30.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 386 2933.00 146382.50 49.91
OCCT-97530-OT SESSION BY LICENSED OT 8 36.25 2460.65 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 3.00 162.96 54.32
PHY-97110-PT SESSION BY LICENSED PT 90 497.25 33749.45 67.87
PHY-97110HM-PT SESSION BY PT ASST 2 3.00 162.96 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 124 586.75 39816.86 67.86
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 7.00 380.24 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 2 5.00 66.00 13.20
Subtotal (Total Children Is Unduplicated) 543 4112.25 232747.27 56.60
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Total 4140.25 234251.77 56.58
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Number of Children (Unduplicated) With at Least One Service 548
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Center 01
Flag Claims Units Chgs Paid
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R 1 1.00 67.88 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 8 7.75 490.31 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
1085 2709.25 148447.25 1100.00
Other 1412 1422.25 85246.33 0.00
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Total 2506 4140.25 234251.77 1100.00