CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2008 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 1730 8447.25 311577.00 36.89
Subtotal (Total Children Is Unduplicated) 1730 8447.25 311577.00 36.89
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 14.00 1050.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.00 444.00 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 125 236.00 13098.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 342 760.00 57000.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 157 157.00 7850.00 50.00
Subtotal (Total Children Is Unduplicated) 443 1175.00 79442.00 67.61
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 1.75 87.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 7.50 375.00 50.00
Subtotal (Total Children Is Unduplicated) 9 9.25 462.50 50.00
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Total 9631.50 391481.50 40.65
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Number of Children (Unduplicated) With at Least One Service 1738
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Center 07
Flag Claims Units Chgs Paid
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R 1 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 5964 4040.75 155466.50 0.00
P 7676 5590.25 235996.50 235931.25
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 13641 9631.50 391481.50 235931.25