CMS/EIP Fiscal Report Center: 51
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 519 1990.75 73639.25 36.99
Subtotal (Total Children Is Unduplicated) 519 1990.75 73639.25 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.50 187.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 3.00 225.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.00 150.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 11.00 825.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 14 19.50 1436.00 73.64
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 12.00 801.85 66.82
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 13 46.00 2300.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 1 1.00 67.88 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 13.00 827.76 63.67
Subtotal (Total Children Is Unduplicated) 17 72.00 3997.49 55.52
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Total 2082.25 79072.74 37.97
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Number of Children (Unduplicated) With at Least One Service 520
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Center 51
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 3139 2069.25 78203.01 0.00
P 2 13.00 869.73 801.85
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 3141 2082.25 79072.74 801.85