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:Program Patients
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 2355 11877.5 439359.00 36.99
Subtotal (Total Children Is Unduplicated) 2355 11877.5 439359.00 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 37 53.00 3937.50 74.29
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.50 562.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 60 102.50 7687.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 84 118.00 6514.00 55.20
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 170 228.50 16862.00 73.79
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 79 147.00 11025.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 340 453.00 25031.00 55.26
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 257 376.00 28200.00 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 50 51.00 2471.08 48.45
Subtotal (Total Children Is Unduplicated) 795 1603.00 105641.08 65.90
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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 280 2595.00 129355.38 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 109 1439.00 96659.67 67.17
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 280 2719.50 183304.84 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) 537 7864.00 478742.92 60.88
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Total 21344.50 1023743.00 47.96
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Number of Children (Unduplicated) With at Least One Service 2370
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Center 01
Flag Claims Units Chgs Paid
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R 23 14.25 527.25 0.00
U 0 0.00 0.00 0.00
B 3510 2411.75 103568.75 9.25
P 6013 4613.50 202734.39 202496.15
D 1050 764.25 28478.75 0.00
S 1149 978.50 36731.00 0.00
H 13 15.50 904.00 0.00
T 140 171.00 10998.00 10933.50
2661 6756.00 417026.75 0.00
Other 8449 5619.75 222774.11 0.00
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Total 23008 21344.50 1023743.00 213438.90