CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Payclass Filters:MED
Eligibility Filter:Not Part C
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 46 151.25 5587.00 36.94
Subtotal (Total Children Is Unduplicated) 46 151.25 5587.00 36.94
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 14.50 804.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 23.00 1725.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 9 9.00 450.00 50.00
Subtotal (Total Children Is Unduplicated) 21 46.50 2979.75 64.08
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Total 197.75 8566.75 43.32
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Number of Children (Unduplicated) With at Least One Service 47
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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 186 157.25 6059.00 0.00
P 12 21.00 1545.75 1545.75
D 0 0.00 0.00 0.00
S 12 12.25 564.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5 7.25 397.75 0.00
Other 0 0.00 0.00 0.00
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Total 215 197.75 8566.75 1545.75