CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 2.210510 107.2097 48.5002
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.000000 291.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.000000 291.0000 48.5000
Subtotal (Total Children Is Unduplicated) 13 14.210510 689.2097 48.5000
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 49.6200 49.6200
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 8.000000 400.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 66.500000 4514.0200 67.8800
PHY-97110-PT SESSION BY LICENSED PT 24 186.250000 12642.6500 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 96.250000 6533.4500 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.750000 62.7000 13.2000
Subtotal (Total Children Is Unduplicated) 44 362.750000 24202.4400 66.7193
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Total 376.960510 24891.6497 66.0325
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Number of Children (Unduplicated) With at Least One Service 50
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Center 53
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
481 376.960510 24891.6497 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 481 376.960510 24891.6497 0.0000