CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 656 1976.75 73102.75 36.98
Subtotal (Total Children Is Unduplicated) 656 1976.75 73102.75 36.98
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 27 36.50 2737.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.00 450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 19 22.00 1650.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 19.50 1462.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 27.00 1498.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 112 127.00 9525.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 38 71.50 5362.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 83 99.00 7425.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 144 225.50 12515.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 33 41.00 3075.00 75.00
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 8 8.00 400.00 50.00
Subtotal (Total Children Is Unduplicated) 269 685.00 46198.25 67.44
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 50 231.75 11587.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 25 142.00 9625.40 67.78
OCCT-97530HM-OT SESSION BY OT ASST 2 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 19 79.50 5396.46 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 2.00 108.64 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 35.00 2375.80 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 89 493.25 29215.64 59.23
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Total 3155.00 148516.64 47.07
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Number of Children (Unduplicated) With at Least One Service 744
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Center 09
Flag Claims Units Chgs Paid
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R 23 17.75 1073.55 0.00
U 0 0.00 0.00 0.00
B 553 560.25 31541.83 152.75
P 2744 2577.00 115901.26 142897.51
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
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Total 3320 3155.00 148516.64 143050.26