CMS/EIP Fiscal Report Center: 57
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 1015 7122.00 263479.00 37.00
Subtotal (Total Children Is Unduplicated) 1015 7122.00 263479.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 11.50 843.00 73.30
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 5.50 412.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 10.00 750.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 30.50 1692.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 179 187.50 13998.50 74.66
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 83 95.00 7125.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 334 357.50 19764.00 55.28
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 101 114.50 8387.50 73.25
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 387 814.00 53073.25 65.20
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EI Services,Class #03
PHY-97110-PT SESSION BY LICENSED PT 3 13.00 882.44 67.88
Subtotal (Total Children Is Unduplicated) 3 13.00 882.44 67.88
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Total 7949.00 317434.69 39.93
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Number of Children (Unduplicated) With at Least One Service 1015
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Center 57
Flag Claims Units Chgs Paid
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R 265 310.00 11755.00 0.00
U 0 0.00 0.00 0.00
B 3422 3427.25 126786.25 64.75
P 3384 3336.75 123497.75 123446.02
D 11 11.50 425.50 0.00
S 1 1.25 46.25 0.00
H 0 0.00 0.00 0.00
T 1 2.00 150.00 150.00
790 859.75 54755.44 111.00
Other 1 0.50 18.50 0.00
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Total 7875 7949.00 317434.69 123771.77