CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
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 1307 3753.25 138768.50 36.97
Subtotal (Total Children Is Unduplicated) 1307 3753.25 138768.50 36.97
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 29.00 2175.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.50 412.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 23 45.00 3375.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 5.00 277.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 155 210.00 15712.50 74.82
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 24.50 1837.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 31.00 2325.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 153 208.50 11571.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 77 106.50 7958.25 74.73
Subtotal (Total Children Is Unduplicated) 238 666.00 45720.00 68.65
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 6.00 300.00 50.00
Subtotal (Total Children Is Unduplicated) 2 6.00 300.00 50.00
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Total 4425.25 184788.50 41.76
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Number of Children (Unduplicated) With at Least One Service 1308
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Center 01
Flag Claims Units Chgs Paid
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R 17 12.00 444.00 0.00
U 0 0.00 0.00 0.00
B 1584 1009.75 39316.50 277.50
P 3285 2304.75 88312.75 88303.50
D 137 91.25 3376.25 0.00
S 714 511.50 19010.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
30 19.50 721.50 0.00
Other 354 476.50 33607.25 92.50
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Total 6121 4425.25 184788.50 88673.50