CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 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 1133 2884.00 106708.00 37.00
Subtotal (Total Children Is Unduplicated) 1133 2884.00 106708.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 15.00 1125.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 8.50 471.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 8.50 637.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 43 55.00 3052.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 73.50 5512.50 75.00
Subtotal (Total Children Is Unduplicated) 87 160.50 10799.25 67.29
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 41.00 2050.00 50.00
Subtotal (Total Children Is Unduplicated) 14 41.00 2050.00 50.00
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Total 3085.50 119557.25 38.75
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Number of Children (Unduplicated) With at Least One Service 1135
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Center 01
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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 971 594.50 22024.25 0.00
H 3 3.00 150.00 0.00
T 103 135.00 8831.00 8831.00
146 110.00 4174.25 0.00
Other 3694 2243.00 84377.75 0.00
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Total 4917 3085.50 119557.25 8831.00