CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 1436 3873.50 143116.00 36.95
Subtotal (Total Children Is Unduplicated) 1436 3873.50 143116.00 36.95
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 27.50 2062.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.50 249.75 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 115 148.50 8241.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 66 77.50 5783.25 74.62
Subtotal (Total Children Is Unduplicated) 183 258.00 16337.25 63.32
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 9.00 450.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 1 1.00 67.88 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 7.00 475.16 67.88
Subtotal (Total Children Is Unduplicated) 9 17.00 993.04 58.41
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Total 4148.50 160446.29 38.68
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Number of Children (Unduplicated) With at Least One Service 1446
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Center 01
Flag Claims Units Chgs Paid
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R 37 22.50 832.50 0.00
U 0 0.00 0.00 0.00
B 1945 1272.25 49395.75 277.50
P 3983 2853.75 110218.04 109515.75
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 5965 4148.50 160446.29 109793.25