CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2008 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 547 1822.25 67404.75 36.99
Subtotal (Total Children Is Unduplicated) 547 1822.25 67404.75 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 4.00 280.50 70.13
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 10.00 555.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 67 67.00 5025.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 86 86.00 4773.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 26.00 1950.00 75.00
Subtotal (Total Children Is Unduplicated) 102 195.00 12733.50 65.30
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Total 2017.25 80138.25 39.73
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Number of Children (Unduplicated) With at Least One Service 547
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Center 57
Flag Claims Units Chgs Paid
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R 126 141.00 5217.00 0.00
U 0 0.00 0.00 0.00
B 1065 1044.75 38637.25 0.00
P 620 582.75 21561.75 21561.65
D 10 10.75 397.75 0.00
S 1 1.25 46.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
228 236.25 14259.75 0.00
Other 1 0.50 18.50 0.00
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Total 2051 2017.25 80138.25 21561.65