CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 1314 4026.00 148749.25 36.95
Subtotal (Total Children Is Unduplicated) 1314 4026.00 148749.25 36.95
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 6.00 450.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.50 637.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.50 305.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 60 101.50 7612.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.50 712.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 10.50 787.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 101.50 5633.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 64.00 4800.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 101 317.00 21423.50 67.58
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 8.00 353.20 44.15
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 30.00 30.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 320 1979.25 98962.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 11 63.25 4293.41 67.88
PHY-97110-PT SESSION BY LICENSED PT 49 276.25 18697.61 67.68
PHY-97110HM-PT SESSION BY PT ASST 9 20.00 1086.40 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 116 440.50 29698.56 67.42
SPL-92508-GROUP SPL SESSION PER CHILD 5 11.00 145.20 13.20
Subtotal (Total Children Is Unduplicated) 445 2799.25 153266.88 54.75
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Total 7142.25 323439.63 45.29
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Number of Children (Unduplicated) With at Least One Service 1353
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Center 01
Flag Claims Units Chgs Paid
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R 248 163.50 6236.75 0.00
U 0 0.00 0.00 0.00
B 3184 2272.25 85691.75 0.00
P 152 191.75 9584.25 9584.25
D 135 182.50 12085.50 0.00
S 2017 1494.00 55139.25 0.00
H 0 0.00 0.00 0.00
T 1 3.00 150.00 200.00
998 1920.75 100003.56 3450.00
Other 592 914.50 54548.57 0.00
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Total 7327 7142.25 323439.63 13234.25