CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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 1098 2698.00 99779.75 36.98
Subtotal (Total Children Is Unduplicated) 1098 2698.00 99779.75 36.98
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 8.50 471.75 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 106 130.00 7215.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 109 120.50 9037.50 75.00
Subtotal (Total Children Is Unduplicated) 177 263.00 17024.25 64.73
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 33.75 1687.50 50.00
Subtotal (Total Children Is Unduplicated) 9 33.75 1687.50 50.00
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Total 2994.75 118491.50 39.57
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Number of Children (Unduplicated) With at Least One Service 1152
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Center 01
Flag Claims Units Chgs Paid
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R 109 123.25 7777.00 0.00
U 0 0.00 0.00 0.00
B 2448 1728.50 66954.25 0.00
P 1568 1143.00 43760.25 43759.75
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 4125 2994.75 118491.50 43759.75