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
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 596 1825.50 67534.25 36.99
Subtotal (Total Children Is Unduplicated) 596 1825.50 67534.25 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 36.00 2700.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.00 300.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 13.50 1012.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 21.00 1575.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 15.50 860.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 95 105.50 7912.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 25.00 1875.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 64 77.00 5775.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 66 102.50 5688.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 13.00 975.00 75.00
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 6 9.00 450.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 175 424.00 29221.00 68.92
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 145 889.00 44450.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 86 467.75 31750.87 67.88
OCCT-97530HM-OT SESSION BY OT ASST 2 4.75 258.02 54.32
PHY-97110-PT SESSION BY LICENSED PT 106 695.75 47227.51 67.88
PHY-97110HM-PT SESSION BY PT ASST 6 50.50 2743.16 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 105 546.25 37079.45 67.88
Subtotal (Total Children Is Unduplicated) 325 2655.00 163534.01 61.59
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Total 4904.50 260289.26 53.07
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Number of Children (Unduplicated) With at Least One Service 710
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Center 09
Flag Claims Units Chgs Paid
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R 5 7.00 372.00 0.00
U 0 0.00 0.00 0.00
B 553 549.50 29366.59 27.75
P 2515 2177.25 95668.91 95568.91
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 0.75 27.75 27.75
T 0 0.00 0.00 0.00
783 2170.00 134854.01 0.00
Other 0 0.00 0.00 0.00
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Total 3857 4904.50 260289.26 95624.41