CMS/EIP Fiscal Report Center: 54
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 706 2194.75 80512.00 36.68
Subtotal (Total Children Is Unduplicated) 706 2194.75 80512.00 36.68
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 7.50 562.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 7.00 388.50 55.50
Subtotal (Total Children Is Unduplicated) 13 15.50 1026.00 66.19
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Total 2210.25 81538.00 36.89
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Number of Children (Unduplicated) With at Least One Service 708
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Center 54
Flag Claims Units Chgs Paid
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R 15 10.50 379.25 0.00
U 0 0.00 0.00 0.00
B 1145 706.50 26227.25 0.00
P 2271 1493.25 54931.50 92185.58
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 3431 2210.25 81538.00 92185.58