CMS/EIP Fiscal Report Center: 57
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:LEA
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
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 1 2.000000 97.0000 48.5000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 994.000000 24850.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 135.000000 6750.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 47 328.500000 22298.5800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 30 160.250000 10877.7700 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 66 415.750000 28221.1100 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 2 1.000000 13.2000 13.2000
Subtotal (Total Children Is Unduplicated) 82 2034.500000 93010.6600 45.7167
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Total 2036.500000 93107.6600 45.7195
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Number of Children (Unduplicated) With at Least One Service 82
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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
433 2036.500000 93107.6600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 433 2036.500000 93107.6600 0.0000