CMS/EIP Fiscal Report Center: 57
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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 5.000000 242.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.000000 291.0000 48.5000
Subtotal (Total Children Is Unduplicated) 11 12.000000 582.0000 48.5000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 480 4494.000000 224700.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 66 446.250000 30291.4500 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 3 11.500000 624.6800 54.3200
PHY-97110-PT SESSION BY LICENSED PT 56 326.250000 22145.8500 67.8800
PHY-97110HM-PT SESSION BY PT ASST 5 31.750000 1724.6600 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 93 576.500000 39132.8200 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 35.500000 1928.3600 54.3200
Subtotal (Total Children Is Unduplicated) 596 5921.750000 320547.8200 54.1306
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Total 5933.750000 321129.8200 54.1192
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Number of Children (Unduplicated) With at Least One Service 601
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Center 57
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
1743 5933.750000 321129.8200 321129.8200
Other 0 0.000000 0.0000 0.0000
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Total 1743 5933.750000 321129.8200 321129.8200