CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 820 2160.75 79947.75 37.00
Subtotal (Total Children Is Unduplicated) 820 2160.75 79947.75 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 40 65.00 4875.00 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 27 41.00 2275.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 140 199.50 14962.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 36.50 2737.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 43.50 3262.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 128 191.50 10628.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 17.50 1312.50 75.00
Subtotal (Total Children Is Unduplicated) 220 642.50 43653.75 67.94
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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 3116.75 141833.34 45.51
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Number of Children (Unduplicated) With at Least One Service 869
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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 2961 2542.25 112390.29 0.00
P 463 510.00 27019.55 27019.55
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
53 55.75 2062.75 0.00
Other 3 2.00 74.00 0.00
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Total 3488 3116.75 141833.34 27019.55