CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2008 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 2387 18420.8 681416.50 36.99
Subtotal (Total Children Is Unduplicated) 2387 18420.8 681416.50 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 105 169.50 12712.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 49 71.50 5362.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 61 88.50 6637.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 31 53.50 4012.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 105 178.50 9906.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 450 721.50 54112.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 285 463.50 34725.00 74.92
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 328 487.50 36562.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 531 879.50 48812.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 396 500.00 37462.50 74.93
Subtotal (Total Children Is Unduplicated) 993 3613.50 250306.50 69.27
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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 110 1212.50 60625.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 16.00 1086.08 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 1.00 67.88 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.50 101.82 67.88
Subtotal (Total Children Is Unduplicated) 113 1232.00 61905.78 50.25
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Total 23266.25 993628.78 42.71
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Number of Children (Unduplicated) With at Least One Service 2398
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Center 10
Flag Claims Units Chgs Paid
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R 5 1.75 64.75 0.00
U 0 0.00 0.00 0.00
B 23151 15928.00 627110.63 153.00
P 8343 7336.50 366453.40 369377.35
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 31499 23266.25 993628.78 369530.35