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
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 1597 4786.00 176786.00 36.94
Subtotal (Total Children Is Unduplicated) 1597 4786.00 176786.00 36.94
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 33.50 2512.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 15 25.50 1912.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 17.50 971.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 156 229.00 17137.50 74.84
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 24.50 1837.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 39 53.50 4012.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 115 161.00 8935.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 91 133.00 9975.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 6.00 291.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 12 12.00 582.00 48.50
Subtotal (Total Children Is Unduplicated) 254 703.50 48687.75 69.21
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 38.00 9475.65 249.36
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 3.00 90.00 30.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 388 2948.00 147132.50 49.91
OCCT-97530-OT SESSION BY LICENSED OT 8 36.25 2460.65 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 3.00 162.96 54.32
PHY-97110-PT SESSION BY LICENSED PT 90 497.25 33749.45 67.87
PHY-97110HM-PT SESSION BY PT ASST 2 3.00 162.96 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 124 586.75 39816.86 67.86
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 7.00 380.24 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 2 5.00 66.00 13.20
Subtotal (Total Children Is Unduplicated) 545 4127.25 233497.27 56.57
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Total 9616.75 458971.02 47.73
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Number of Children (Unduplicated) With at Least One Service 1641
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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 4688 3219.75 127395.00 9.25
P 1905 1284.75 48387.31 47860.00
D 69 43.75 1618.75 0.00
S 855 665.75 28461.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1097 2717.75 148799.75 1100.00
Other 1588 1676.75 103934.58 0.00
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Total 10218 9616.75 458971.02 48969.25