CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 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 805 2085.00 77145.00 37.00
Subtotal (Total Children Is Unduplicated) 805 2085.00 77145.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 31 49.50 3712.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.00 375.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 18.00 1350.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 25.50 1912.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 17.00 943.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 179 246.50 18487.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 38 58.00 4350.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 99 126.50 9487.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 123 194.00 10767.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 29.00 2175.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 5 8.00 400.00 50.00
Subtotal (Total Children Is Unduplicated) 295 777.00 53960.50 69.45
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 59 317.50 15875.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 32 155.25 10538.37 67.88
PHY-97110-PT SESSION BY LICENSED PT 21 99.50 6754.06 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 15.75 1069.11 67.88
Subtotal (Total Children Is Unduplicated) 105 588.00 34236.54 58.23
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Total 3450.00 165342.04 47.93
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Number of Children (Unduplicated) With at Least One Service 902
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Center 09
Flag Claims Units Chgs Paid
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R 15 16.00 629.00 27.75
U 0 0.00 0.00 0.00
B 1024 983.50 50177.64 335.00
P 2782 2450.50 114535.40 114475.64
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 3821 3450.00 165342.04 114838.39