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: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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 34.50 2625.00 76.09
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 38.50 2925.00 75.97
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 35 84.00 6136.50 73.05
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 23.00 1150.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 122 600.50 40761.94 67.88
PHY-97110-PT SESSION BY LICENSED PT 117 632.00 42900.16 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 14.00 760.48 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 158 745.25 50587.57 67.88
Subtotal (Total Children Is Unduplicated) 267 2014.75 136160.15 67.58
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Total 2098.75 142296.65 67.80
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Number of Children (Unduplicated) With at Least One Service 286
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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 35 25.25 1728.21 3313.12
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
1338 2073.50 140568.44 193.73
Other 0 0.00 0.00 0.00
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Total 1373 2098.75 142296.65 3506.85