CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 84 111.50 8362.50 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 44 50.50 3787.50 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 285 325.00 24375.00 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 215 259.50 19462.50 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 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 16 19.00 950.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 658 1805.50 123347.25 68.32
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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 91 896.50 44727.00 49.89
OCCT-97530-OT SESSION BY LICENSED OT 56 586.75 39815.03 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 23 156.50 10623.22 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
Subtotal (Total Children Is Unduplicated) 154 1927.00 114288.42 59.31
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Total 11475.25 523888.17 45.65
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Number of Children (Unduplicated) With at Least One Service 1336
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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 10094 9479.50 417942.57 549234.72
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
22 25.75 1536.45 18.50
Other 0 0.00 0.00 0.00
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Total 12139 11475.25 523888.17 550056.72