CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 863 2304.25 85155.50 36.96
Subtotal (Total Children Is Unduplicated) 863 2304.25 85155.50 36.96
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 46.50 3487.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.00 450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 22.00 1650.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 18.00 1350.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 23.00 1276.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 188 267.00 20025.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 34 62.00 4650.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 102 135.00 10125.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 125 185.50 10295.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 33.00 2475.00 75.00
Subtotal (Total Children Is Unduplicated) 287 798.00 55784.25 69.91
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 53 217.00 10850.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 18 104.00 7059.52 67.88
PHY-97110-PT SESSION BY LICENSED PT 16 82.25 5583.13 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 6.75 458.19 67.88
Subtotal (Total Children Is Unduplicated) 90 410.00 23950.84 58.42
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Total 3512.25 164890.59 46.95
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Number of Children (Unduplicated) With at Least One Service 958
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Center 09
Flag Claims Units Chgs Paid
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R 117 85.75 3388.25 0.00
U 0 0.00 0.00 0.00
B 3160 2720.00 127245.16 46.25
P 753 706.50 34257.18 117288.68
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 4030 3512.25 164890.59 117334.93