CMS/EIP Fiscal Report Center: 52
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 474 1342.25 49654.00 36.99
Subtotal (Total Children Is Unduplicated) 474 1342.25 49654.00 36.99
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 7.50 416.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 56 85.00 6375.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 26.00 1950.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 77 118.50 6576.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 16.50 1237.50 75.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 101 268.00 17510.50 65.34
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 2.00 50.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 31 137.50 6875.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 2 16.00 1086.08 67.88
PHY-97110-PT SESSION BY LICENSED PT 12 44.00 2986.72 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 116.75 7924.99 67.88
Subtotal (Total Children Is Unduplicated) 61 316.25 18922.79 59.83
----------------------------------------------------------------------------------------------------------------
Total 1926.50 86087.29 44.69
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 480
----------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 92 77.50 4542.67 0.00
P 2774 1849.00 81544.62 81535.37
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
-------------------------------------------------
Total 2866 1926.50 86087.29 81535.37