CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 933 2750.00 101687.25 36.98
Subtotal (Total Children Is Unduplicated) 933 2750.00 101687.25 36.98
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 36.00 2700.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.50 412.50 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 12 20.50 1537.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 16.00 888.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 162 242.00 18112.50 74.85
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 46.50 3487.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 45.00 3375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 136 214.50 11849.25 55.24
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 41.00 3075.00 75.00
Subtotal (Total Children Is Unduplicated) 221 669.00 45587.25 68.14
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 48 202.50 10125.00 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) 72 355.75 20527.61 57.70
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Total 3774.75 167802.11 44.45
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Number of Children (Unduplicated) With at Least One Service 979
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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 4065 3617.25 159174.11 0.00
P 84 108.50 6811.25 6810.75
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 50.00 50.00
T 0 0.00 0.00 0.00
50 43.00 1581.75 0.00
Other 0 0.00 0.00 0.00
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Total 4204 3774.75 167802.11 6860.75