CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
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 5 5.25 194.25 37.00
Subtotal (Total Children Is Unduplicated) 5 5.25 194.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 33.00 2475.00 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 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 43.50 2379.25 54.70
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 84 112.50 8162.00 72.55
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 60 114.00 8550.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 70 106.50 5819.50 54.64
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) 291 531.00 33533.83 63.15
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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 255 2379.00 118572.13 49.84
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 105 1390.00 93598.12 67.34
PHY-97110HM-PT SESSION BY PT ASST 6 141.00 7659.12 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 278 2711.50 182809.08 67.42
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) 512 7586.00 464152.36 61.19
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Total 8122.25 497880.44 61.30
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Number of Children (Unduplicated) With at Least One Service 643
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Center 01
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 0 0.00 0.00 0.00
P 522 1317.25 78010.63 78010.63
D 0 0.00 0.00 0.00
S 2 4.00 261.00 0.00
H 1 1.00 25.00 0.00
T 1 1.00 50.00 0.00
2452 6547.25 405196.70 0.00
Other 241 251.75 14337.11 0.00
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Total 3219 8122.25 497880.44 78010.63