CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Payclass Filters:MED
Eligibility Filter:Not Part C
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 324 857.00 31709.00 37.00
Subtotal (Total Children Is Unduplicated) 324 857.00 31709.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 15.00 1125.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.00 450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 16 16.00 1200.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 16 21.00 1575.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 33.00 1831.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 140 152.50 11437.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 106.50 7987.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 85 99.00 7425.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 171 280.00 15540.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 103.00 7650.00 74.27
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 12 12.00 600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 318 849.00 57064.00 67.21
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EI Services,Class #03
PHY-97110-PT SESSION BY LICENSED PT 1 2.00 135.76 67.88
Subtotal (Total Children Is Unduplicated) 1 2.00 135.76 67.88
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Total 1708.00 88908.76 52.05
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Number of Children (Unduplicated) With at Least One Service 367
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Center 09
Flag Claims Units Chgs Paid
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R 8 13.00 783.00 0.00
U 0 0.00 0.00 0.00
B 168 224.50 12994.51 75.00
P 1167 1458.25 74328.00 74337.20
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
10 12.25 803.25 9.25
Other 0 0.00 0.00 0.00
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Total 1353 1708.00 88908.76 74421.45