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:Program Patients
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 1585 4596.50 169867.00 36.96
Subtotal (Total Children Is Unduplicated) 1585 4596.50 169867.00 36.96
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 31.00 2325.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.00 225.00 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 25 47.00 3525.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 7.00 388.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 231 299.00 22387.50 74.87
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 34.00 2550.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 54.00 4050.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 225 299.50 16622.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 116 155.00 11595.75 74.81
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) 362 964.00 65488.00 67.93
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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 340 2255.50 112775.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 16 65.75 4463.11 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 63 359.50 24402.86 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 132 630.00 42758.58 67.87
SPL-92508-GROUP SPL SESSION PER CHILD 5 21.50 283.80 13.20
Subtotal (Total Children Is Unduplicated) 493 3335.25 185002.94 55.47
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Total 8895.75 420357.94 47.25
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Number of Children (Unduplicated) With at Least One Service 1674
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Center 01
Flag Claims Units Chgs Paid
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R 37 22.50 832.50 0.00
U 0 0.00 0.00 0.00
B 1945 1272.25 49395.75 277.50
P 3983 2853.75 110218.04 109515.75
D 146 97.50 3607.50 0.00
S 839 605.50 22501.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
927 2169.50 117032.88 371.52
Other 1486 1874.75 116770.02 92.50
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Total 9363 8895.75 420357.94 110257.27