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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 34.500000 1725.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 30 110.500000 8172.3100 73.9576
OCCT-97530HM-OT SESSION BY OT ASST 3 4.000000 710.6800 177.6700
PHY-97110-PT SESSION BY LICENSED PT 27 104.000000 8849.7400 85.0937
PHY-97110HM-PT SESSION BY PT ASST 2 3.000000 425.0000 141.6667
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 81 263.750000 18199.8700 69.0042
SPL-92508-GROUP SPL SESSION PER CHILD 1 5.000000 66.0000 13.2000
Subtotal (Total Children Is Unduplicated) 130 525.750000 38173.6000 72.6079
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Total 525.750000 38173.6000 72.6079
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Number of Children (Unduplicated) With at Least One Service 130
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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
796 525.750000 38173.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 796 525.750000 38173.6000 0.0000