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: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 82 39.50 1461.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 136 160.00 5920.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 133 441.00 16317.00 37.00
Subtotal (Total Children Is Unduplicated) 196 640.50 23698.50 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.50 138.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 44 66.00 4950.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 10.00 750.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 44.50 2469.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 28.00 2100.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 65 155.50 10719.50 68.94
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 41 1656.00 828.00 0.50
Subtotal (Total Children Is Unduplicated) 41 1657.00 878.00 0.53
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Total 2453.00 35296.00 14.39
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Number of Children (Unduplicated) With at Least One Service 205
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Center 01
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 104 1239.50 7419.00 7419.00
D 0 0.00 0.00 0.00
S 49 53.00 1961.00 0.00
H 0 0.00 0.00 0.00
T 39 454.50 2874.75 2874.75
841 599.50 22559.50 0.00
Other 7 106.50 481.75 0.00
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Total 1040 2453.00 35296.00 10293.75