CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
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 568 1768.75 65334.75 36.94
Subtotal (Total Children Is Unduplicated) 568 1768.75 65334.75 36.94
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 34.50 2587.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 17.00 1275.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 16.50 1237.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 21.00 1165.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 84 97.00 7275.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 41.00 3075.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 56 66.00 4950.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 100 146.00 8103.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 31.00 2325.00 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 6 6.00 300.00 50.00
Subtotal (Total Children Is Unduplicated) 188 480.00 32540.50 67.79
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 50 232.75 11637.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 25 147.00 9964.80 67.79
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 7 37.50 2545.50 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 89 501.75 29774.74 59.34
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Total 2750.50 127649.99 46.41
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Number of Children (Unduplicated) With at Least One Service 634
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Center 09
Flag Claims Units Chgs Paid
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R 21 15.75 948.55 0.00
U 0 0.00 0.00 0.00
B 527 527.75 29621.33 77.75
P 2425 2164.25 94677.50 121673.75
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.75 64.75 64.75
T 0 0.00 0.00 0.00
36 39.75 2291.61 0.00
Other 2 1.25 46.25 0.00
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Total 3012 2750.50 127649.99 121816.25