CMS/EIP Fiscal Report Center: 10
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 1020 4032.00 149137.75 36.99
Subtotal (Total Children Is Unduplicated) 1020 4032.00 149137.75 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 40.00 3000.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 16.00 1200.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 14.00 1050.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.00 600.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 32.00 1776.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 92 149.50 11212.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 69 111.00 8325.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 59 97.50 7312.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 169.00 9379.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 81 99.50 7425.00 74.62
Subtotal (Total Children Is Unduplicated) 191 736.50 51280.50 69.63
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 86.25 4312.50 50.00
Subtotal (Total Children Is Unduplicated) 16 86.25 4312.50 50.00
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Total 4854.75 204730.75 42.17
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Number of Children (Unduplicated) With at Least One Service 1022
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Center 10
Flag Claims Units Chgs Paid
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R 2 1.75 64.75 0.00
U 0 0.00 0.00 0.00
B 6251 3984.25 148869.75 0.00
P 595 808.25 52993.75 53021.50
D 75 59.50 2752.50 2752.50
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1 1.00 50.00 0.00
Other 0 0.00 0.00 0.00
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Total 6924 4854.75 204730.75 55774.00