CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 373 976.00 35964.00 36.85
Subtotal (Total Children Is Unduplicated) 373 976.00 35964.00 36.85
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.50 412.50 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 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.50 471.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 31.00 2325.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 16.00 1200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 70.00 3885.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 15.00 1125.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.00 242.50 48.50
Subtotal (Total Children Is Unduplicated) 68 155.50 9999.25 64.30
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 34 123.50 6175.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 4 20.50 1391.54 67.88
PHY-97110-PT SESSION BY LICENSED PT 4 6.00 407.28 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 75.00 5091.00 67.88
Subtotal (Total Children Is Unduplicated) 61 225.00 13064.82 58.07
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Total 1356.50 59028.07 43.51
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Number of Children (Unduplicated) With at Least One Service 382
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Center 52
Flag Claims Units Chgs Paid
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R 3 5.00 375.00 0.00
U 0 0.00 0.00 0.00
B 2059 1351.50 58653.07 0.00
P 0 0.00 0.00 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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
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Total 2062 1356.50 59028.07 0.00