CMS/EIP Fiscal Report Center: 55
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 309 881.75 32393.50 36.74
Subtotal (Total Children Is Unduplicated) 309 881.75 32393.50 36.74
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 33 49.00 3675.00 75.00
Subtotal (Total Children Is Unduplicated) 33 49.00 3675.00 75.00
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Total 930.75 36068.50 38.75
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Number of Children (Unduplicated) With at Least One Service 309
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Center 55
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 9 9.25 399.25 0.00
P 943 892.25 34548.50 34586.00
D 0 0.00 0.00 0.00
S 12 13.25 528.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
15 16.00 592.00 0.00
Other 0 0.00 0.00 0.00
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Total 979 930.75 36068.50 34586.00