CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 1051 3985.00 147445.00 37.00
Subtotal (Total Children Is Unduplicated) 1051 3985.00 147445.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 11.50 862.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 25.50 1912.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.50 562.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.50 187.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 31.00 1720.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 75 129.50 9712.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 92.00 6900.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 95.00 7125.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 68 126.50 7020.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 74.50 5587.50 75.00
Subtotal (Total Children Is Unduplicated) 140 595.50 41591.25 69.84
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 43.00 1075.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 105 780.25 39012.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 54 193.75 13050.05 67.36
OCCT-97530HM-OT SESSION BY OT ASST 9 19.00 1032.08 54.32
PHY-97110-PT SESSION BY LICENSED PT 99 404.75 27474.43 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 2.00 108.64 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 96 297.00 20132.36 67.79
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.00 108.64 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 2 8.50 112.20 13.20
Subtotal (Total Children Is Unduplicated) 253 1750.25 102105.90 58.34
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Total 6330.75 291142.15 45.99
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Number of Children (Unduplicated) With at Least One Service 1064
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Center 10
Flag Claims Units Chgs Paid
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R 58 44.75 1655.75 0.00
U 0 0.00 0.00 0.00
B 4096 2720.75 104929.00 9.25
P 2361 1683.50 77142.00 77142.00
D 4 3.00 111.00 111.00
S 250 128.50 5198.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
743 1750.25 102105.90 0.00
Other 0 0.00 0.00 0.00
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Total 7512 6330.75 291142.15 77262.25