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: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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 97.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 4 4.000000 194.0000 48.5000
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 22 171.250000 10606.8000 61.9375
OCCT-97530HM-OT SESSION BY OT ASST 3 5.000000 141.2200 28.2440
PHY-97110-PT SESSION BY LICENSED PT 40 217.250000 14101.5300 64.9092
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 247.500000 16199.1600 65.4512
Subtotal (Total Children Is Unduplicated) 83 641.000000 41048.7100 64.0385
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Total 645.000000 41242.7100 63.9422
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Number of Children (Unduplicated) With at Least One Service 84
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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 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
304 645.000000 41242.7100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 304 645.000000 41242.7100 0.0000