CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
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 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 1 1.000000 48.5000 48.5000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 197 1114.000000 55700.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 31 157.750000 10708.0700 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 4 35.750000 1941.9400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 39 199.750000 13559.0300 67.8800
PHY-97110HM-PT SESSION BY PT ASST 3 2.750000 149.3800 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 281.500000 19108.2200 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 1 6.000000 79.2000 13.2000
Subtotal (Total Children Is Unduplicated) 287 1797.500000 101245.8400 56.3259
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Total 1798.500000 101294.3400 56.3216
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Number of Children (Unduplicated) With at Least One Service 287
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Center 06
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
2088 1798.500000 101294.3400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2088 1798.500000 101294.3400 0.0000