CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 345 872.50 32162.25 36.86
Subtotal (Total Children Is Unduplicated) 345 872.50 32162.25 36.86
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.50 487.50 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 21 33.50 2512.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 12.00 900.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 34 54.00 2997.00 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) 56 139.00 9073.75 65.28
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 41 189.50 9475.00 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) 68 291.00 16364.82 56.24
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Total 1302.50 57600.82 44.22
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Number of Children (Unduplicated) With at Least One Service 353
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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 1893 1215.25 52925.57 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 24 20.50 1043.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
66 61.75 3256.75 0.00
Other 0 0.00 0.00 0.00
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Total 1986 1302.50 57600.82 0.00