CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
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 738 2988.50 110186.00 36.87
Subtotal (Total Children Is Unduplicated) 738 2988.50 110186.00 36.87
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 52 83.50 6225.00 74.55
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 37.50 2812.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 39 56.00 4087.50 72.99
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 140.00 7575.75 54.11
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 8.00 600.00 75.00
Subtotal (Total Children Is Unduplicated) 122 326.00 21375.75 65.57
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 1.00 67.88 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.00 54.32 54.32
Subtotal (Total Children Is Unduplicated) 4 4.00 222.20 55.55
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Total 3318.50 131783.95 39.71
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Number of Children (Unduplicated) With at Least One Service 738
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Center 02
Flag Claims Units Chgs Paid
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R 10 6.50 240.50 0.00
U 0 0.00 0.00 0.00
B 3512 2674.00 98623.50 0.00
P 0 0.00 0.00 0.00
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
500 638.00 32919.95 0.00
Other 0 0.00 0.00 0.00
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Total 4022 3318.50 131783.95 0.00