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:TPIN
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 6 5.25 194.25 37.00
Subtotal (Total Children Is Unduplicated) 6 5.25 194.25 37.00
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 17.00 1275.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.50 262.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 29.00 2137.50 73.71
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 11.00 610.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 70 94.50 7087.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 30.50 2287.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 24.00 1800.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 77 111.00 6105.00 55.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 70.50 5287.50 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 2.00 145.56 72.78
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 3.75 183.50 48.93
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 139 405.75 27674.56 68.21
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 10.00 2304.08 230.41
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 11.50 575.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.50 125.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 57 237.75 12036.99 50.63
OCCT-97530-OT SESSION BY LICENSED OT 19 81.50 5821.53 71.43
OCCT-97530HM-OT SESSION BY OT ASST 1 1.00 67.88 67.88
PHY-97110-PT SESSION BY LICENSED PT 57 232.89 16728.60 71.83
PHY-97110HM-PT SESSION BY PT ASST 1 5.00 271.60 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 160 665.25 46529.40 69.94
SPL-92508-GROUP SPL SESSION PER CHILD 2 8.00 105.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 121.00 60.50 0.50
Subtotal (Total Children Is Unduplicated) 248 1377.39 84676.18 61.48
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Total 1788.39 112544.99 62.93
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Number of Children (Unduplicated) With at Least One Service 360
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Center 01
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 7 7.50 509.14 135.76
D 107 146.50 9045.75 0.00
S 0 0.00 0.00 0.00
H 11 18.50 1220.56 0.00
T 0 0.00 0.00 0.00
527 726.89 43691.99 135.76
Other 868 889.00 58077.55 0.00
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Total 1520 1788.39 112544.99 271.52