CMS/EIP Fiscal Report Center: 10
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 1347 4715.75 174482.75 37.00
Subtotal (Total Children Is Unduplicated) 1347 4715.75 174482.75 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 22.50 1687.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 8.50 637.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 22.50 1687.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 30.50 1692.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 119 207.00 15525.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 90 149.50 11212.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 86 141.50 10612.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 174 311.50 17288.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 99 110.00 8250.00 75.00
Subtotal (Total Children Is Unduplicated) 291 1007.50 68893.50 68.38
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Total 5723.25 243376.25 42.52
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Number of Children (Unduplicated) With at Least One Service 1352
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Center 10
Flag Claims Units Chgs Paid
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R 684 438.00 17217.75 0.00
U 0 0.00 0.00 0.00
B 6743 4507.50 180490.75 0.00
P 704 777.75 45667.75 45612.25
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 8131 5723.25 243376.25 45612.25