CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
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
Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.00 36.07 36.07
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 10.00 723.50 72.35
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 17 18.50 1387.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 57 60.00 4500.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 38.50 2887.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 16.00 1200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 23.50 1304.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 155 184.00 13570.50 73.75
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 23 27.00 1309.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 16 18.00 825.50 45.86
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 15 18.00 873.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 42 42.00 2037.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 39 43.00 2085.50 48.50
Subtotal (Total Children Is Unduplicated) 279 505.00 33068.62 65.48
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.00 508.02 127.01
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 32.00 2349.44 73.42
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 12.00 300.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 226 3251.25 162216.50 49.89
OCCT-97530-OT SESSION BY LICENSED OT 94 1208.75 81837.73 67.70
OCCT-97530HM-OT SESSION BY OT ASST 29 239.25 12996.06 54.32
PHY-97110-PT SESSION BY LICENSED PT 121 1296.25 87769.06 67.71
PHY-97110HM-PT SESSION BY PT ASST 37 309.00 16704.90 54.06
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 123 1297.75 87677.35 67.56
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 12.25 665.42 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 14 30.25 399.30 13.20
Subtotal (Total Children Is Unduplicated) 347 7692.75 453423.78 58.94
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Total 8197.75 486492.40 59.34
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Number of Children (Unduplicated) With at Least One Service 444
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Center 51
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 1 1.00 67.88 0.00
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
3328 8196.75 486424.52 0.00
Other 0 0.00 0.00 0.00
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Total 3329 8197.75 486492.40 0.00