CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:MED
Eligibility Filter:DEI Only
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 106 159.00 5883.00 37.00
Subtotal (Total Children Is Unduplicated) 106 159.00 5883.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.50 150.00 60.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 7.50 416.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 24.00 1800.00 75.00
Subtotal (Total Children Is Unduplicated) 22 36.00 2496.75 69.35
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 19.00 950.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 1 1.00 67.88 67.88
Subtotal (Total Children Is Unduplicated) 6 20.00 1017.88 50.89
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Total 215.00 9397.63 43.71
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Number of Children (Unduplicated) With at Least One Service 108
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Center 01
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 181 123.00 4720.00 0.00
P 15 12.50 462.50 462.50
D 0 0.00 0.00 0.00
S 40 27.75 1026.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8 10.00 535.88 0.00
Other 40 41.75 2652.50 0.00
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Total 284 215.00 9397.63 462.50