CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 1450 7952.25 293382.25 36.89
Subtotal (Total Children Is Unduplicated) 1450 7952.25 293382.25 36.89
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 8.00 600.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 139 265.00 14707.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 294 652.00 48900.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 114 114.00 5700.00 50.00
Subtotal (Total Children Is Unduplicated) 360 1043.00 70129.50 67.24
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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 9004.50 363974.25 40.42
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Number of Children (Unduplicated) With at Least One Service 1452
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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 5538 3667.50 140484.75 0.00
P 7020 4996.50 209984.50 209919.25
D 3 1.25 46.25 0.00
S 449 315.50 12580.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
22 23.25 860.25 0.00
Other 0 0.00 0.00 0.00
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Total 13033 9004.50 363974.25 209919.25