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:EIP DEI DEIP
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 9900.75 366219.25 36.99
Subtotal (Total Children Is Unduplicated) 1888 9900.75 366219.25 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 39 71.50 5362.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 53.50 2969.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 39 55.50 4162.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 167 216.50 12004.75 55.45
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 172 262.50 19687.50 75.00
Subtotal (Total Children Is Unduplicated) 304 665.00 44599.00 67.07
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 24 163.50 8175.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 5 29.50 1738.00 58.92
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 5.00 250.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 6.00 360.00 60.00
Subtotal (Total Children Is Unduplicated) 29 204.00 10523.00 51.58
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Total 10769.75 421341.25 39.12
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Number of Children (Unduplicated) With at Least One Service 1893
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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 4714 2765.00 103695.50 103495.26
D 807 585.50 21865.00 0.00
S 952 783.50 29289.50 0.00
H 9 10.50 608.25 0.00
T 115 143.50 9151.25 9136.75
85 53.25 2092.25 0.00
Other 6964 4459.50 171839.25 0.00
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Total 16625 10769.75 421341.25 112641.26