CMS/EIP Fiscal Report Center: 09
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 1068 3039.75 112417.25 36.98
Subtotal (Total Children Is Unduplicated) 1068 3039.75 112417.25 36.98
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 27 44.00 3300.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.00 525.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 23.50 1762.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 22.50 1248.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 264 377.50 28275.00 74.90
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 47 77.50 5812.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 78.50 5887.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 231 354.00 19591.50 55.34
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 59.00 4425.00 75.00
Subtotal (Total Children Is Unduplicated) 354 1045.50 70977.75 67.89
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 48 201.50 10075.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 10 60.25 4089.77 67.88
PHY-97110-PT SESSION BY LICENSED PT 11 47.00 3190.36 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 46.00 3122.48 67.88
Subtotal (Total Children Is Unduplicated) 72 354.75 20477.61 57.72
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Total 4440.00 203872.61 45.92
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Number of Children (Unduplicated) With at Least One Service 1137
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Center 09
Flag Claims Units Chgs Paid
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R 4 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 4562 4288.00 194144.86 0.00
P 117 147.00 9542.75 9542.25
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 4683 4440.00 203872.61 9542.25