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
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 1269 7742.75 286252.50 36.97
Subtotal (Total Children Is Unduplicated) 1269 7742.75 286252.50 36.97
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 89 116.50 8737.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 17.00 1275.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 49 55.50 4162.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 65 87.50 6562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 43 65.00 3607.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 288 328.50 24637.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 139.00 10425.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 216 260.50 19537.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 330 518.50 28776.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 142 205.00 15375.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 9.00 436.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 16 19.00 950.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.00 533.50 48.50
Subtotal (Total Children Is Unduplicated) 668 1842.00 125501.75 68.13
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 4.00 100.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 226 2722.50 136027.00 49.96
OCCT-97530-OT SESSION BY LICENSED OT 192 1997.75 135559.77 67.86
OCCT-97530HM-OT SESSION BY OT ASST 7 12.75 692.58 54.32
PHY-97110-PT SESSION BY LICENSED PT 195 2638.50 179101.38 67.88
PHY-97110HM-PT SESSION BY PT ASST 13 205.50 11162.76 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 229 2087.25 141682.53 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 565 9669.25 604339.22 62.50
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Total 19254.00 1016093.47 52.77
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Number of Children (Unduplicated) With at Least One Service 1349
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Center 09
Flag Claims Units Chgs Paid
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R 154 144.75 7514.23 0.00
U 0 0.00 0.00 0.00
B 1865 1819.00 96663.67 572.25
P 10095 9481.50 418078.33 549370.48
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 4 6.25 231.25 231.25
T 0 0.00 0.00 0.00
2892 7802.50 493605.99 18.50
Other 0 0.00 0.00 0.00
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Total 15010 19254.00 1016093.47 550192.48