CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2008 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 702 2043.25 75591.00 37.00
Subtotal (Total Children Is Unduplicated) 702 2043.25 75591.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 30 41.00 3075.00 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 16.50 1237.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 15 24.00 1800.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 25.50 1415.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 135 149.00 11175.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 71.50 5362.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 81 94.00 7050.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 113 178.00 9879.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 19.00 1425.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 12 15.00 750.00 50.00
Subtotal (Total Children Is Unduplicated) 268 639.50 43619.25 68.21
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 55 241.00 12050.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 26 162.50 11030.50 67.88
PHY-97110-PT SESSION BY LICENSED PT 16 76.00 5158.88 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 11.50 780.62 67.88
Subtotal (Total Children Is Unduplicated) 88 491.00 29020.00 59.10
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Total 3173.75 148230.25 46.71
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Number of Children (Unduplicated) With at Least One Service 767
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Center 09
Flag Claims Units Chgs Paid
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R 7 8.50 427.50 0.00
U 0 0.00 0.00 0.00
B 582 588.25 31642.34 27.75
P 2830 2577.00 116160.41 116060.41
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 3419 3173.75 148230.25 116088.16