CMS/EIP Fiscal Report Center: 57
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
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 12 12.000000 582.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 8 8.000000 388.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 15 15.000000 727.5000 48.5000
Subtotal (Total Children Is Unduplicated) 28 37.000000 1794.5000 48.5000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 483 4351.750000 217587.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 61 398.500000 27050.1800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 68 299.500000 20330.0600 67.8800
PHY-97110HM-PT SESSION BY PT ASST 6 31.500000 1711.0800 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 91 497.000000 33736.3600 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 13.500000 733.3200 54.3200
Subtotal (Total Children Is Unduplicated) 577 5591.750000 301148.5000 53.8559
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Total 5628.750000 302943.0000 53.8207
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Number of Children (Unduplicated) With at Least One Service 579
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Center 57
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
1769 5628.750000 302943.0000 302943.0000
Other 0 0.000000 0.0000 0.0000
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Total 1769 5628.750000 302943.0000 302943.0000