CMS/EIP Fiscal Report Center: 54
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 716 2328.75 85867.75 36.87
Subtotal (Total Children Is Unduplicated) 716 2328.75 85867.75 36.87
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 9.00 675.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 7.50 562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 8.00 444.00 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 51.50 3862.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 51.50 2858.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 66.00 4950.00 75.00
Subtotal (Total Children Is Unduplicated) 110 193.50 13352.25 69.00
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 84 436.25 21812.50 50.00
Subtotal (Total Children Is Unduplicated) 84 436.25 21812.50 50.00
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Total 2958.50 121032.50 40.91
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Number of Children (Unduplicated) With at Least One Service 731
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Center 54
Flag Claims Units Chgs Paid
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R 3 1.75 64.75 0.00
U 0 0.00 0.00 0.00
B 1241 1058.25 50598.00 0.00
P 2875 1898.50 70369.75 70369.75
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 4119 2958.50 121032.50 70369.75