CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 18 18.00 873.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 17 17.00 824.50 48.50
Subtotal (Total Children Is Unduplicated) 30 35.00 1697.50 48.50
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 5.00 250.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 45 204.50 13881.46 67.88
PHY-97110-PT SESSION BY LICENSED PT 22 95.00 6448.60 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 179.50 12184.46 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 8 26.50 1439.48 54.32
Subtotal (Total Children Is Unduplicated) 86 510.50 34204.00 67.00
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Total 545.50 35901.50 65.81
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Number of Children (Unduplicated) With at Least One Service 92
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Center 04
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 258 545.50 35901.50 35602.74
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
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Total 258 545.50 35901.50 35602.74