CMS/EIP Fiscal Report Center: 07
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 958 3036.00 112313.50 36.99
Subtotal (Total Children Is Unduplicated) 958 3036.00 112313.50 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 40.00 3000.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.50 862.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.50 187.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 84 162.00 8991.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 118 321.00 24000.00 74.77
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 38 38.00 1900.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 20 20.00 970.00 48.50
Subtotal (Total Children Is Unduplicated) 193 608.00 40760.50 67.04
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 391 2772.75 138637.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 28 241.50 16393.02 67.88
PHY-97110-PT SESSION BY LICENSED PT 18 128.75 8739.55 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 55 409.75 27813.83 67.88
Subtotal (Total Children Is Unduplicated) 455 3553.75 191633.90 53.92
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Total 7197.75 344707.90 47.89
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Number of Children (Unduplicated) With at Least One Service 1023
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Center 07
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 11 8.00 296.00 0.00
P 4847 3261.25 133146.75 133146.75
D 0 0.00 0.00 0.00
S 271 134.75 4976.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1315 3792.75 206251.65 0.00
Other 2 1.00 37.00 0.00
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Total 6446 7197.75 344707.90 133146.75