CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2008 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 720 2071.25 76534.50 36.95
Subtotal (Total Children Is Unduplicated) 720 2071.25 76534.50 36.95
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.50 412.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 47 93.00 5161.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 101 282.00 21150.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 20 20.00 1000.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 134 420.50 28814.00 68.52
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 215 1350.50 67525.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 14 51.25 3275.21 63.91
OCCT-97530HM-OT SESSION BY OT ASST 1 5.00 271.60 54.32
PHY-97110-PT SESSION BY LICENSED PT 11 22.25 1303.75 58.60
PHY-97110HM-PT SESSION BY PT ASST 4 6.00 325.92 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.50 125.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 79.75 5413.43 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.50 81.48 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
Subtotal (Total Children Is Unduplicated) 249 1519.25 78327.99 51.56
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Total 4011.00 183676.49 45.79
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Number of Children (Unduplicated) With at Least One Service 773
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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 1964 1394.25 56000.25 0.00
P 1140 841.50 36375.25 36360.00
D 1 0.50 18.50 0.00
S 149 112.75 4726.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
652 1661.50 86537.24 0.00
Other 0 0.00 0.00 0.00
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Total 3907 4011.00 183676.49 36360.00