CMS/EIP Fiscal Report Center: 06
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-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.00 750.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.00 555.00 55.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 8.00 388.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 19 34.00 1984.00 58.35
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 132 822.50 41125.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 29 131.00 8892.28 67.88
PHY-97110-PT SESSION BY LICENSED PT 73 366.25 24861.05 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 5.00 271.60 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 136 683.25 46379.01 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 3 14.50 191.40 13.20
Subtotal (Total Children Is Unduplicated) 294 2022.50 121720.34 60.18
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Total 2056.50 123704.34 60.15
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Number of Children (Unduplicated) With at Least One Service 303
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Center 06
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
2444 2056.50 123704.34 0.00
Other 0 0.00 0.00 0.00
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Total 2444 2056.50 123704.34 0.00