CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 531 1329.25 49182.25 37.00
Subtotal (Total Children Is Unduplicated) 531 1329.25 49182.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 24.50 1837.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 21.50 1612.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 43.50 2414.25 55.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 56 56.00 2800.00 50.00
Subtotal (Total Children Is Unduplicated) 83 149.50 8925.25 59.70
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 24.00 1200.00 50.00
Subtotal (Total Children Is Unduplicated) 4 24.00 1200.00 50.00
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Total 1502.75 59307.50 39.47
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Number of Children (Unduplicated) With at Least One Service 536
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Center 03
Flag Claims Units Chgs Paid
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R 4 2.50 120.25 0.00
U 0 0.00 0.00 0.00
B 660 469.25 18830.25 37.00
P 1339 1031.00 40357.00 40357.00
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 2003 1502.75 59307.50 40394.00