CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:GR
Eligibility Filter:Not Part C
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 29 20.25 749.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 49 73.00 2701.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 35 133.00 4921.00 37.00
Subtotal (Total Children Is Unduplicated) 57 226.25 8371.25 37.00
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 2.00 100.00 50.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.00 75.00 37.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 14.50 1087.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.50 175.00 70.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 17.00 1275.00 75.00
Subtotal (Total Children Is Unduplicated) 19 38.00 2712.50 71.38
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 25 1235.00 605.00 0.49
Subtotal (Total Children Is Unduplicated) 25 1235.00 605.00 0.49
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Total 1499.25 11688.75 7.80
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Number of Children (Unduplicated) With at Least One Service 57
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Center 51
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 0 0.00 0.00 0.00
P 65 1265.00 2717.50 2717.50
D 2 2.50 92.50 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
313 231.75 8878.75 0.00
Other 0 0.00 0.00 0.00
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Total 380 1499.25 11688.75 2717.50