CMS/EIP Fiscal Report Center: 57
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 14 5.25 194.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 53 53.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 30 21.25 786.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 33 143.75 5318.75 37.00
Subtotal (Total Children Is Unduplicated) 64 223.25 6299.25 28.22
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 24.00 1800.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 32.50 1803.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 5.50 412.50 75.00
Subtotal (Total Children Is Unduplicated) 27 66.00 4277.25 64.81
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Total 289.25 10576.50 36.57
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Number of Children (Unduplicated) With at Least One Service 64
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Center 57
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 0 0.00 0.00 0.00
D 14 17.75 750.75 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
240 271.50 9825.75 0.00
Other 0 0.00 0.00 0.00
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Total 254 289.25 10576.50 0.00