CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 1074 2980.00 110260.00 37.00
Subtotal (Total Children Is Unduplicated) 1074 2980.00 110260.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 5.50 294.25 53.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 55.00 4125.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 74.50 4134.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 44.00 3300.00 75.00
Subtotal (Total Children Is Unduplicated) 87 186.00 12379.00 66.55
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 36.00 1800.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 5.00 250.00 50.00
Subtotal (Total Children Is Unduplicated) 11 41.00 2050.00 50.00
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Total 3207.00 124689.00 38.88
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Number of Children (Unduplicated) With at Least One Service 1081
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Center 01
Flag Claims Units Chgs Paid
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R 8 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 2797 1990.75 74239.25 0.00
P 309 201.75 7464.75 7464.70
D 4 1.25 46.25 0.00
S 911 702.50 25992.50 0.00
H 0 0.00 0.00 0.00
T 1 1.25 46.25 0.00
89 70.50 2916.50 0.00
Other 200 234.00 13798.50 0.00
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Total 4319 3207.00 124689.00 7464.70