CMS/EIP Fiscal Report Center: 57
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
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 6.00 291.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 6 6.00 291.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 18 18.00 873.00 48.50
Subtotal (Total Children Is Unduplicated) 27 35.00 1697.50 48.50
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 427 3682.00 184100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 33 107.00 7263.16 67.88
PHY-97110-PT SESSION BY LICENSED PT 54 180.00 12218.40 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 71 269.00 18259.72 67.88
Subtotal (Total Children Is Unduplicated) 495 4238.00 221841.28 52.35
----------------------------------------------------------------------------------------------------------------
Total 4273.00 223538.78 52.31
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 498
----------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
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 1 2.00 100.00 100.00
1403 4271.00 223438.78 204164.52
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1404 4273.00 223538.78 204264.52