CMS/EIP Fiscal Report Center: 09
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 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 29.50 1637.25 55.50
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.00 242.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 28 43.00 2331.75 54.23
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 248 1813.00 90650.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 131 913.00 61974.44 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 5.50 298.76 54.32
PHY-97110-PT SESSION BY LICENSED PT 129 796.50 54066.42 67.88
PHY-97110HM-PT SESSION BY PT ASST 8 52.00 2824.64 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 211 1538.75 104450.35 67.88
Subtotal (Total Children Is Unduplicated) 509 5118.75 314264.61 61.39
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Total 5161.75 316596.36 61.34
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Number of Children (Unduplicated) With at Least One Service 525
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Center 09
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
1827 5161.75 316596.36 0.00
Other 0 0.00 0.00 0.00
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Total 1827 5161.75 316596.36 0.00