CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 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 4 5.000000 242.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 6 7.000000 339.5000 48.5000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 541 3761.000000 188050.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 58 321.000000 21789.4800 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 108.6400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 89 675.750000 45869.9100 67.8800
PHY-97110HM-PT SESSION BY PT ASST 22 131.000000 7115.9200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 91 557.750000 37860.0700 67.8800
Subtotal (Total Children Is Unduplicated) 699 5448.500000 300794.0200 55.2068
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Total 5455.500000 301133.5200 55.1982
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Number of Children (Unduplicated) With at Least One Service 700
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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 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
1869 5455.500000 301133.5200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1869 5455.500000 301133.5200 0.0000