CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 1749 5110.00 188980.00 36.98
Subtotal (Total Children Is Unduplicated) 1749 5110.00 188980.00 36.98
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 26.00 1950.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 45 76.00 5700.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 52.00 2885.25 55.49
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 33.00 2475.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 144 183.00 10137.25 55.39
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 126 207.00 15525.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.00 242.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 274 595.00 39545.50 66.46
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 102 584.25 29032.50 49.69
OCCT-97530-OT SESSION BY LICENSED OT 27 158.25 10741.91 67.88
OCCT-97530HM-OT SESSION BY OT ASST 3 23.75 1262.94 53.18
PHY-97110-PT SESSION BY LICENSED PT 44 270.25 17678.77 65.42
PHY-97110HM-PT SESSION BY PT ASST 1 10.00 543.20 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 53 290.25 19128.82 65.90
Subtotal (Total Children Is Unduplicated) 168 1336.75 78388.14 58.64
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Total 7041.75 306913.64 43.58
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Number of Children (Unduplicated) With at Least One Service 1781
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Center 01
Flag Claims Units Chgs Paid
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R 24 15.00 555.00 0.00
U 0 0.00 0.00 0.00
B 3510 2411.75 103568.75 9.25
P 6015 4615.00 202789.89 202551.65
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 9549 7041.75 306913.64 202560.90