CMS/EIP Fiscal Report Center: 07
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 1692 8696.75 320808.50 36.89
Subtotal (Total Children Is Unduplicated) 1692 8696.75 320808.50 36.89
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Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.00 36.07 36.07
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 14.00 1050.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 12.00 666.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.00 675.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 8.00 600.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 283 540.50 29994.75 55.49
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 390 851.50 63823.50 74.95
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 10 11.00 533.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 15.00 727.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 7.00 339.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 157 157.00 7850.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 15 17.00 824.50 48.50
Subtotal (Total Children Is Unduplicated) 565 1653.50 107724.24 65.15
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 372 4028.50 201225.00 49.95
OCCT-97530-OT SESSION BY LICENSED OT 29 254.75 17088.79 67.08
OCCT-97530HM-OT SESSION BY OT ASST 1 5.00 271.60 54.32
PHY-97110-PT SESSION BY LICENSED PT 15 67.75 4358.35 64.33
PHY-97110HM-PT SESSION BY PT ASST 5 10.00 543.20 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 7.50 375.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 261.75 17748.98 67.81
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.50 81.48 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 427 4637.75 241705.60 52.12
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Total 14988.00 670238.34 44.72
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Number of Children (Unduplicated) With at Least One Service 1698
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Center 07
Flag Claims Units Chgs Paid
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R 1 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 5936 4018.00 154624.75 0.00
P 7642 5556.75 234605.00 234539.75
D 4 1.75 64.75 0.00
S 472 337.75 13625.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
2079 5073.25 267300.09 0.00
Other 0 0.00 0.00 0.00
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Total 16134 14988.00 670238.34 234539.75