CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2012 ending 09/30/2012 Date of Report:11/16/2012 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
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 6 7.500000 434.2500 57.9000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 97.168000 4858.4000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 9.946376 675.1600 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 217.2800 54.3200
PHY-97110-PT SESSION BY LICENSED PT 1 7.000000 475.1600 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 36.662100 2488.6239 67.8800
Subtotal (Total Children Is Unduplicated) 35 154.776476 8714.6239 56.3046
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Total 162.276476 9148.8739 56.3783
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Number of Children (Unduplicated) With at Least One Service 38
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Center 53
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 2 2.000000 100.0000 100.0000
T 0 0.000000 0.0000 0.0000
165 160.276476 9048.8739 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 167 162.276476 9148.8739 100.0000