CMS/EIP Fiscal Report Center: 55
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 758 4190.50 154921.00 36.97
Subtotal (Total Children Is Unduplicated) 758 4190.50 154921.00 36.97
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 9.00 675.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 19.50 1082.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 113 168.50 12600.00 74.78
Subtotal (Total Children Is Unduplicated) 130 199.00 14468.25 72.70
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Total 4389.50 169389.25 38.59
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Number of Children (Unduplicated) With at Least One Service 758
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Center 55
Flag Claims Units Chgs Paid
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R 39 47.50 1757.50 0.00
U 0 0.00 0.00 0.00
B 88 122.00 8294.50 0.00
P 4178 4220.00 159337.25 159336.75
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 4305 4389.50 169389.25 159336.75