CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 1307 3753.25 138768.50 36.97
Subtotal (Total Children Is Unduplicated) 1307 3753.25 138768.50 36.97
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 29.00 2175.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.50 412.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 23 45.00 3375.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 5.00 277.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 156 211.00 15787.50 74.82
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 24.50 1837.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 31.00 2325.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 154 210.00 11655.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 77 106.50 7958.25 74.73
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 18.00 873.00 48.50
Subtotal (Total Children Is Unduplicated) 256 697.50 47284.75 67.79
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 210.95 210.95
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 330 2152.50 107625.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 15 62.75 4259.47 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 62 347.50 23588.30 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 130 604.00 40993.70 67.87
SPL-92508-GROUP SPL SESSION PER CHILD 4 17.50 231.00 13.20
Subtotal (Total Children Is Unduplicated) 480 3187.25 177017.06 55.54
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Total 7638.00 363070.31 47.53
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Number of Children (Unduplicated) With at Least One Service 1391
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Center 01
Flag Claims Units Chgs Paid
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R 17 12.00 444.00 0.00
U 0 0.00 0.00 0.00
B 1584 1009.75 39316.50 277.50
P 3292 2315.75 89005.79 88303.50
D 137 91.25 3376.25 0.00
S 715 512.50 19060.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
889 2047.50 110445.93 371.52
Other 1309 1649.25 101421.59 92.50
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Total 7943 7638.00 363070.31 89045.02