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:TPIN
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.00 97.00 48.50
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 45.50 3244.00 71.30
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.00 97.00 48.50
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 7.00 445.50 63.64
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 31.00 1692.75 54.60
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 10.00 750.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 8 11.00 535.40 48.67
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.00 194.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 13.00 630.50 48.50
Subtotal (Total Children Is Unduplicated) 65 128.00 7848.65 61.32
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 2.75 137.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.75 37.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 118.99 5913.46 49.70
OCCT-97530-OT SESSION BY LICENSED OT 34 152.77 10369.69 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 3.00 162.96 54.32
PHY-97110-PT SESSION BY LICENSED PT 45 338.40 22993.63 67.95
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 136 598.27 40578.44 67.83
SPL-92508-GROUP SPL SESSION PER CHILD 4 17.00 224.40 13.20
Subtotal (Total Children Is Unduplicated) 189 1231.93 80417.58 65.28
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Total 1359.93 88266.23 64.90
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Number of Children (Unduplicated) With at Least One Service 222
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Center 52
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 0.89 60.41 60.41
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 47 75.50 4636.65 0.00
T 0 0.00 0.00 0.00
555 1283.54 83569.17 173.78
Other 0 0.00 0.00 0.00
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Total 603 1359.93 88266.23 234.19