CMS/EIP Fiscal Report Center: 10
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 1849 15997.5 591765.50 36.99
Subtotal (Total Children Is Unduplicated) 1849 15997.5 591765.50 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 77 133.50 10012.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 39 58.50 4387.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 43 65.00 4875.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 19 36.50 2737.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 75 137.00 7603.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 310 510.00 38250.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 191 321.00 24037.50 74.88
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 231 363.50 27262.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 322 559.00 31024.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 268 340.50 25500.00 74.89
Subtotal (Total Children Is Unduplicated) 664 2524.50 175690.50 69.59
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 109 1215.50 60775.00 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 4 6.50 441.22 67.88
Subtotal (Total Children Is Unduplicated) 114 1239.00 62370.18 50.34
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Total 19761.00 829826.18 41.99
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Number of Children (Unduplicated) With at Least One Service 1852
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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 20765 13615.00 530800.31 153.00
P 7079 5895.00 288861.15 289922.85
D 198 139.25 5664.25 5765.25
S 174 109.00 4385.72 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1 1.00 50.00 0.00
Other 0 0.00 0.00 0.00
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Total 28222 19761.00 829826.18 295841.10