CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
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 1594 8592.50 317693.25 36.97
Subtotal (Total Children Is Unduplicated) 1594 8592.50 317693.25 36.97
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 97 125.50 9412.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 23.00 1725.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 59 65.50 4912.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 79 106.50 7987.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 63 98.00 5439.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 422 473.50 35512.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 130 247.50 18562.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 299 357.50 26812.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 501 799.50 44372.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 218 307.00 22950.00 74.76
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 28 31.00 1550.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 976 2643.50 179672.75 67.97
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 3.00 75.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 91 896.50 44727.00 49.89
OCCT-97530-OT SESSION BY LICENSED OT 56 581.75 39475.63 67.86
OCCT-97530HM-OT SESSION BY OT ASST 3 4.00 217.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 27 271.25 18412.45 67.88
PHY-97110HM-PT SESSION BY PT ASST 3 7.00 380.24 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 150.50 10215.94 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 154 1915.00 113516.74 59.28
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Total 13151.00 610882.74 46.45
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Number of Children (Unduplicated) With at Least One Service 1705
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Center 09
Flag Claims Units Chgs Paid
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R 162 157.75 8297.23 0.00
U 0 0.00 0.00 0.00
B 2034 2044.50 109733.18 647.25
P 11269 10948.75 492852.33 624153.68
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
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Total 13465 13151.00 610882.74 624800.93