CMS/EIP Fiscal Report Center: 07
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 40.500000 3037.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 30.000000 1665.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 66.000000 4950.0000 75.0000
Subtotal (Total Children Is Unduplicated) 46 149.500000 10627.5000 71.0870
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 444 3055.500000 152775.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 27.500000 1866.7000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 2 2.000000 135.7600 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 55.000000 3733.4000 67.8800
Subtotal (Total Children Is Unduplicated) 455 3140.000000 158510.8600 50.4812
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Total 3289.500000 169138.3600 51.4177
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Number of Children (Unduplicated) With at Least One Service 470
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Center 07
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
1213 3289.500000 169138.3600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1213 3289.500000 169138.3600 0.0000