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: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 5 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.500000 562.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 44.000000 3300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 44.500000 3337.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 145.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 39 110.500000 8102.0000 73.3213
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 44.000000 2200.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 78.500000 5328.5800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 48 225.000000 15273.0000 67.8800
PHY-97110HM-PT SESSION BY PT ASST 2 5.000000 271.6000 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 210.000000 14254.8000 67.8800
Subtotal (Total Children Is Unduplicated) 103 562.500000 37327.9800 66.3609
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Total 673.000000 45429.9800 67.5037
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Number of Children (Unduplicated) With at Least One Service 136
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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 52 137.000000 8472.1600 8472.1630
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
320 536.000000 36957.8200 799.8000
Other 0 0.000000 0.0000 0.0000
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Total 372 673.000000 45429.9800 9271.9630