CMS/EIP Fiscal Report Center: 10
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 4 4.000000 194.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.000000 291.0000 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 577 5043.000000 252030.0000 49.9762
OCCT-97530-OT SESSION BY LICENSED OT 69 489.000000 33193.3200 67.8800
PHY-97110-PT SESSION BY LICENSED PT 69 363.500000 24674.3800 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 63 402.500000 27321.7000 67.8800
Subtotal (Total Children Is Unduplicated) 677 6298.000000 337219.4000 53.5439
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Total 6308.000000 337704.4000 53.5359
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Number of Children (Unduplicated) With at Least One Service 679
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Center 10
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 1 4.000000 200.0000 40.0000
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
2090 6304.000000 337504.4000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2091 6308.000000 337704.4000 40.0000