CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 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
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.000000 242.5000 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) 10 10.000000 485.0000 48.5000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 518 3566.000000 178300.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 36 283.500000 19243.9800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 98 667.500000 45309.9000 67.8800
PHY-97110HM-PT SESSION BY PT ASST 15 81.000000 4399.9200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 81 558.000000 37877.0400 67.8800
Subtotal (Total Children Is Unduplicated) 652 5156.000000 285130.8400 55.3008
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Total 5166.000000 285615.8400 55.2876
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Number of Children (Unduplicated) With at Least One Service 653
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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
1691 5166.000000 285615.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1691 5166.000000 285615.8400 0.0000