CMS/EIP Fiscal Report Center: 10
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 1203 4336.75 160459.75 37.00
Subtotal (Total Children Is Unduplicated) 1203 4336.75 160459.75 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 28.00 2100.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 11.00 825.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 15.50 1162.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 32.00 1776.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 135 240.00 18000.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 134.00 10050.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 93 154.00 11550.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 156 293.50 16289.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 103 122.00 9150.00 75.00
Subtotal (Total Children Is Unduplicated) 264 1036.00 71352.75 68.87
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 0.50 33.94 67.88
Subtotal (Total Children Is Unduplicated) 1 0.50 33.94 67.88
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Total 5373.25 231846.44 43.15
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Number of Children (Unduplicated) With at Least One Service 1219
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Center 10
Flag Claims Units Chgs Paid
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R 19 9.25 342.25 0.00
U 0 0.00 0.00 0.00
B 5947 3990.25 158086.75 0.00
P 1502 1373.75 73417.44 73383.50
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 7468 5373.25 231846.44 73383.50