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:Program Patients
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 1593 8599.75 317961.50 36.97
Subtotal (Total Children Is Unduplicated) 1593 8599.75 317961.50 36.97
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 103 131.50 9862.50 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 65 71.50 5362.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 81 108.50 8137.50 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 428 481.00 36075.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 129 245.50 18412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 301 359.50 26962.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 501 798.50 44316.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 218 308.00 23025.00 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 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 8 11.00 533.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 28 31.00 1550.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 14.00 679.00 48.50
Subtotal (Total Children Is Unduplicated) 986 2691.00 182565.75 67.84
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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 196 2640.50 179237.14 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) 566 9671.25 604474.98 62.50
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Total 20962.00 1105002.23 52.71
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Number of Children (Unduplicated) With at Least One Service 1716
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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 2033 2043.50 109658.18 647.25
P 11262 10939.75 492406.33 623707.68
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
2902 7814.75 494409.24 27.75
Other 0 0.00 0.00 0.00
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Total 16363 20962.00 1105002.23 624613.93