CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 890 2625.25 97134.25 37.00
Subtotal (Total Children Is Unduplicated) 890 2625.25 97134.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 7.50 562.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 6.00 450.00 75.00
Subtotal (Total Children Is Unduplicated) 7 13.50 1012.50 75.00
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Total 2638.75 98146.75 37.19
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Number of Children (Unduplicated) With at Least One Service 893
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Center 06
Flag Claims Units Chgs Paid
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R 26 15.25 564.25 0.00
U 0 0.00 0.00 0.00
B 192 121.50 4495.50 434.75
P 3893 2502.00 93087.00 93087.00
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 4111 2638.75 98146.75 93521.75