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
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 1888 9906.00 366413.50 36.99
Subtotal (Total Children Is Unduplicated) 1888 9906.00 366413.50 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 37.00 2775.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.50 412.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 40 73.50 5512.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 66 97.00 5348.50 55.14
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 123 168.00 12324.50 73.36
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.00 225.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 61 115.50 8662.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 237 323.00 17824.25 55.18
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 172 262.50 19687.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 11 11.00 533.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 11.00 513.00 46.64
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 25 27.00 1309.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 12 12.00 582.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 49 50.00 2422.58 48.45
Subtotal (Total Children Is Unduplicated) 584 1196.00 78132.83 65.33
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 12.00 6091.55 507.63
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 152.00 3505.00 23.06
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 270 2542.50 126747.13 49.85
OCCT-97530-OT SESSION BY LICENSED OT 63 646.75 43726.46 67.61
OCCT-97530HM-OT SESSION BY OT ASST 7 148.50 8039.36 54.14
PHY-97110-PT SESSION BY LICENSED PT 107 1419.50 95336.12 67.16
PHY-97110HM-PT SESSION BY PT ASST 6 141.00 7659.12 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 5.00 250.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 279 2717.50 183169.08 67.40
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.00 108.64 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.25 42.90 13.20
Subtotal (Total Children Is Unduplicated) 525 7790.00 474675.36 60.93
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Total 18892.00 919221.69 48.66
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Number of Children (Unduplicated) With at Least One Service 1902
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Center 01
Flag Claims Units Chgs Paid
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R 21 13.75 508.75 0.00
U 0 0.00 0.00 0.00
B 2958 1955.25 82291.50 9.25
P 5236 4082.25 181706.13 181505.89
D 807 585.50 21865.00 0.00
S 954 787.50 29550.50 0.00
H 10 11.50 633.25 0.00
T 116 144.50 9201.25 9136.75
2537 6600.50 407288.95 0.00
Other 7205 4711.25 186176.36 0.00
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Total 19844 18892.00 919221.69 190651.89