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:TPIN
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 5 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.500000 562.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 30.000000 2250.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 33.500000 2512.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 25 80.500000 5984.5000 74.3416
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 74.000000 3700.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 54 228.000000 15476.6400 67.8800
PHY-97110-PT SESSION BY LICENSED PT 81 373.750000 25370.1500 67.8800
PHY-97110HM-PT SESSION BY PT ASST 6 15.500000 841.9600 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 70 303.000000 20567.6400 67.8800
Subtotal (Total Children Is Unduplicated) 146 994.250000 65956.3900 66.3378
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Total 1074.750000 71940.8900 66.9373
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Number of Children (Unduplicated) With at Least One Service 168
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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 0 0.000000 0.0000 0.0000
P 59 168.250000 10084.1300 10260.3200
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
549 906.500000 61856.7600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 608 1074.750000 71940.8900 10260.3200