CMS/EIP Fiscal Report Center: 10
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 6 6.000000 291.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 12 14.000000 679.0000 48.5000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 286 2674.000000 133700.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 104 359.250000 24385.8900 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 16 38.000000 2064.1600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 206 692.250000 46989.9300 67.8800
PHY-97110HM-PT SESSION BY PT ASST 2 2.500000 135.8000 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 163 671.000000 45547.4800 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 10 21.500000 1167.8800 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.2000 13.2000
Subtotal (Total Children Is Unduplicated) 560 4459.500000 254004.3400 56.9580
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Total 4473.500000 254683.3400 56.9316
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Number of Children (Unduplicated) With at Least One Service 562
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Center 10
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
1675 4473.500000 254683.3400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1675 4473.500000 254683.3400 0.0000