CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2008 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 298 581.00 21432.25 36.89
Subtotal (Total Children Is Unduplicated) 298 581.00 21432.25 36.89
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 38.00 2812.50 74.01
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 11.00 825.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 16.00 1162.50 72.66
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 43.00 2275.50 52.92
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
Subtotal (Total Children Is Unduplicated) 37 109.00 7150.50 65.60
----------------------------------------------------------------------------------------------------------------
Total 690.00 28582.75 41.42
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 301
----------------------------------------------------------------------------------------------------------------
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 6.50 240.50 0.00
U 0 0.00 0.00 0.00
B 727 523.75 19314.00 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
116 159.75 9028.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 853 690.00 28582.75 0.00