CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
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 450 1104.50 40866.50 37.00
Subtotal (Total Children Is Unduplicated) 450 1104.50 40866.50 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 41.50 3112.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 40.50 2247.75 55.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 70 70.00 3500.00 50.00
Subtotal (Total Children Is Unduplicated) 87 154.00 9010.25 58.51
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Total 1258.50 49876.75 39.63
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Number of Children (Unduplicated) With at Least One Service 462
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Center 03
Flag Claims Units Chgs Paid
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R 11 5.50 203.50 0.00
U 0 0.00 0.00 0.00
B 540 451.50 19096.50 9.25
P 966 801.50 30576.75 30563.75
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
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Total 1517 1258.50 49876.75 30573.00