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
Eligibility Filter:Program Patients
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 658 1990.00 73521.00 36.95
Subtotal (Total Children Is Unduplicated) 658 1990.00 73521.00 36.95
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 33 42.50 3187.50 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 24 27.00 2025.00 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 125 140.00 10500.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 40 75.00 5625.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 88 104.00 7800.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 154 236.00 13098.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 43.00 3225.00 75.00
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 8 8.00 400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 287 734.00 49562.50 67.52
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 114 692.75 34637.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 88 513.75 34859.79 67.85
OCCT-97530HM-OT SESSION BY OT ASST 4 6.00 325.92 54.32
PHY-97110-PT SESSION BY LICENSED PT 113 648.25 44003.21 67.88
PHY-97110HM-PT SESSION BY PT ASST 10 67.75 3680.18 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 109 584.00 39641.92 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 306 2513.50 157161.72 62.53
----------------------------------------------------------------------------------------------------------------
Total 5237.50 280245.22 53.51
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 806
----------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
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 2742 2576.00 115864.26 142860.51
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
813 2080.50 131654.58 0.00
Other 2 1.25 46.25 0.00
-------------------------------------------------
Total 4134 5237.50 280245.22 143078.01