CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 993 2339.75 86561.50 37.00
Subtotal (Total Children Is Unduplicated) 993 2339.75 86561.50 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 3.50 194.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 36.50 2737.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 55.50 3080.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 40.50 3037.50 75.00
Subtotal (Total Children Is Unduplicated) 65 138.50 9237.00 66.69
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 43.00 2150.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 5.00 250.00 50.00
Subtotal (Total Children Is Unduplicated) 11 48.00 2400.00 50.00
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Total 2526.25 98198.50 38.87
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Number of Children (Unduplicated) With at Least One Service 997
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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 776 509.25 18842.25 0.00
P 4 5.00 222.00 0.00
D 161 129.00 4786.00 0.00
S 416 328.25 12145.25 0.00
H 6 7.50 458.25 0.00
T 1 0.50 18.50 0.00
65 37.25 1378.25 0.00
Other 2380 1509.50 60348.00 0.00
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Total 3809 2526.25 98198.50 0.00