CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
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 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.00 194.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 43 43.00 2085.50 48.50
Subtotal (Total Children Is Unduplicated) 48 49.00 2376.50 48.50
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 37 157.68 10703.21 67.88
PHY-97110-PT SESSION BY LICENSED PT 60 231.00 15680.28 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 98 355.04 24100.18 67.88
Subtotal (Total Children Is Unduplicated) 140 743.72 50483.67 67.88
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Total 792.72 52860.17 66.68
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Number of Children (Unduplicated) With at Least One Service 170
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Center 57
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 3 1.72 116.71 116.72
D 0 0.00 0.00 0.00
S 1 1.00 67.88 67.88
H 0 0.00 0.00 0.00
T 1 1.50 101.82 101.82
385 788.50 52573.76 41271.74
Other 0 0.00 0.00 0.00
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Total 390 792.72 52860.17 41558.16