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: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 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 43.000000 3225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 43.500000 3262.5000 75.0000
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 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 30 97.500000 7233.0000 74.1846
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 46.000000 2300.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 80.500000 5464.3400 67.8800
PHY-97110-PT SESSION BY LICENSED PT 56 299.250000 20313.0900 67.8800
PHY-97110HM-PT SESSION BY PT ASST 3 5.000000 271.6000 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 212.500000 14424.5000 67.8800
Subtotal (Total Children Is Unduplicated) 109 643.250000 42773.5300 66.4960
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Total 740.750000 50006.5300 67.5080
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Number of Children (Unduplicated) With at Least One Service 135
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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 45 127.000000 7798.2800 7798.2800
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
323 613.750000 42208.2500 131.2000
Other 0 0.000000 0.0000 0.0000
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Total 368 740.750000 50006.5300 7929.4800