CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Payclass Filters:MED
Eligibility Filter:Not Part C
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 218 710.50 26168.25 36.83
Subtotal (Total Children Is Unduplicated) 218 710.50 26168.25 36.83
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 43 80.50 4466.25 55.48
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 115.50 8662.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 43 43.00 2150.00 50.00
Subtotal (Total Children Is Unduplicated) 104 250.00 16064.75 64.26
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Total 960.50 42233.00 43.97
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Number of Children (Unduplicated) With at Least One Service 221
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Center 07
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 393 347.75 14038.25 0.00
P 583 521.00 22903.25 22903.25
D 1 0.50 18.50 0.00
S 23 22.25 1045.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
39 69.00 4227.75 0.00
Other 0 0.00 0.00 0.00
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Total 1039 960.50 42233.00 22903.25