CMS/EIP Fiscal Report Center: 09
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 3 5.000000 295.5000 59.1000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 334 2627.000000 131350.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 77 462.000000 31360.5600 67.8800
PHY-97110-PT SESSION BY LICENSED PT 109 635.750000 43154.7100 67.8800
PHY-97110HM-PT SESSION BY PT ASST 8 48.000000 2607.3600 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 160 1085.000000 73649.8000 67.8800
Subtotal (Total Children Is Unduplicated) 521 4857.750000 282122.4300 58.0768
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Total 4862.750000 282417.9300 58.0778
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Number of Children (Unduplicated) With at Least One Service 522
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Center 09
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 1 2.000000 150.0000 0.0000
P 1 1.000000 67.8800 18.5000
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
1599 4859.750000 282200.0500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1601 4862.750000 282417.9300 18.5000