CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 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 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 6 6.000000 291.0000 48.5000
Subtotal (Total Children Is Unduplicated) 8 8.000000 388.0000 48.5000
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 531 3566.500000 178325.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 60 386.500000 26235.6200 67.8800
PHY-97110-PT SESSION BY LICENSED PT 91 709.000000 48126.9200 67.8800
PHY-97110HM-PT SESSION BY PT ASST 7 51.000000 2770.3200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 84 526.000000 35704.8800 67.8800
Subtotal (Total Children Is Unduplicated) 688 5239.000000 291162.7400 55.5760
-----------------------------------------------------------------------------------------------------------------------
Total 5247.000000 291550.7400 55.5652
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 689
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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
1781 5247.000000 291550.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1781 5247.000000 291550.7400 0.0000