CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 1785 4893.00 180735.75 36.94
Subtotal (Total Children Is Unduplicated) 1785 4893.00 180735.75 36.94
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.00 900.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 24.50 1837.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 22.50 1248.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 65 91.50 6825.00 74.59
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 166 223.00 12376.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 62 78.50 5887.50 75.00
Subtotal (Total Children Is Unduplicated) 250 456.00 29375.25 64.42
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 17.00 850.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 4 3.75 254.55 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 3.00 203.64 67.88
Subtotal (Total Children Is Unduplicated) 11 23.75 1308.19 55.08
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Total 5372.75 211419.19 39.35
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Number of Children (Unduplicated) With at Least One Service 1804
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Center 01
Flag Claims Units Chgs Paid
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R 16 8.25 374.13 0.00
U 0 0.00 0.00 0.00
B 5437 3823.75 153010.00 9.25
P 2236 1540.75 58035.06 57507.75
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 7689 5372.75 211419.19 57517.00