CMS/EIP Fiscal Report Center: 54
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 1379 8062.75 295454.25 36.64
Subtotal (Total Children Is Unduplicated) 1379 8062.75 295454.25 36.64
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 40 49.00 3675.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 33 35.50 1970.25 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 26.00 1950.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 81 92.00 5106.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 177 224.50 16725.00 74.50
Subtotal (Total Children Is Unduplicated) 261 431.00 29726.25 68.97
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 68 397.00 19825.50 49.94
OCCT-97530-OT SESSION BY LICENSED OT 1 2.25 152.73 67.88
Subtotal (Total Children Is Unduplicated) 69 399.25 19978.23 50.04
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Total 8893.00 345158.73 38.81
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Number of Children (Unduplicated) With at Least One Service 1391
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Center 54
Flag Claims Units Chgs Paid
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R 17 11.25 407.00 0.00
U 0 0.00 0.00 0.00
B 4726 3168.25 119646.48 0.00
P 8395 5713.50 225105.25 262112.61
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 13138 8893.00 345158.73 262112.61