CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 790 2188.50 80872.75 36.95
Subtotal (Total Children Is Unduplicated) 790 2188.50 80872.75 36.95
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 28 42.50 3187.50 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 13 16.00 1200.00 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 14 21.00 1165.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 130 196.00 14700.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 46.00 3450.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 66 94.00 7050.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 87 137.50 7631.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 21.00 1575.00 75.00
Subtotal (Total Children Is Unduplicated) 203 598.00 41759.25 69.83
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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 18 105.00 7127.40 67.88
PHY-97110-PT SESSION BY LICENSED PT 16 83.25 5651.01 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 6.75 458.19 67.88
Subtotal (Total Children Is Unduplicated) 90 412.00 24086.60 58.46
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Total 3198.50 146718.60 45.87
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Number of Children (Unduplicated) With at Least One Service 851
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Center 09
Flag Claims Units Chgs Paid
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R 107 70.50 2691.00 0.00
U 0 0.00 0.00 0.00
B 2955 2470.00 113453.66 46.25
P 686 625.50 29252.68 112284.18
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
41 32.50 1321.26 0.00
Other 0 0.00 0.00 0.00
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Total 3789 3198.50 146718.60 112330.43