CMS/EIP Fiscal Report Center: 57
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 509 1749.50 64620.50 36.94
Subtotal (Total Children Is Unduplicated) 509 1749.50 64620.50 36.94
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 16.00 1200.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.50 187.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 21.50 1193.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 102 118.50 8887.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 119 152.00 8436.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 18.50 1387.50 75.00
Subtotal (Total Children Is Unduplicated) 136 329.00 21291.75 64.72
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 6.00 300.00 50.00
Subtotal (Total Children Is Unduplicated) 1 6.00 300.00 50.00
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Total 2084.50 86212.25 41.36
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Number of Children (Unduplicated) With at Least One Service 519
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Center 57
Flag Claims Units Chgs Paid
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R 242 244.00 9553.50 0.00
U 0 0.00 0.00 0.00
B 369 376.75 15993.25 0.00
P 1247 1330.75 52116.75 52116.75
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
124 133.00 8548.75 0.00
Other 0 0.00 0.00 0.00
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Total 1982 2084.50 86212.25 52116.75