CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 882 2255.00 83435.00 37.00
Subtotal (Total Children Is Unduplicated) 882 2255.00 83435.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 41 66.00 4950.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 11.00 825.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.00 450.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 16 31.00 2325.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 42.00 2331.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 202 277.00 20775.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 30 49.00 3675.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 51 73.50 5512.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 174 253.50 14069.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 29.00 2175.00 75.00
Subtotal (Total Children Is Unduplicated) 299 838.00 57087.75 68.12
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 39 170.50 8525.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 13 73.25 4972.21 67.88
PHY-97110-PT SESSION BY LICENSED PT 11 62.75 4259.47 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 7.00 475.16 67.88
Subtotal (Total Children Is Unduplicated) 58 313.50 18231.84 58.16
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Total 3406.50 158754.59 46.60
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Number of Children (Unduplicated) With at Least One Service 966
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Center 09
Flag Claims Units Chgs Paid
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R 8 6.75 286.75 0.00
U 0 0.00 0.00 0.00
B 3189 2811.50 126879.29 0.00
P 524 588.25 31588.55 31588.55
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 3721 3406.50 158754.59 31588.55