CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:MED
Eligibility Filter:Not Part C
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 23 92.50 3422.50 37.00
Subtotal (Total Children Is Unduplicated) 23 92.50 3422.50 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.00 750.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.00 600.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 12.00 666.00 55.50
Subtotal (Total Children Is Unduplicated) 9 30.00 2016.00 67.20
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Total 122.50 5438.50 44.40
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Number of Children (Unduplicated) With at Least One Service 23
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Center 02
Flag Claims Units Chgs Paid
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R 8 7.75 286.75 0.00
U 0 0.00 0.00 0.00
B 80 76.25 2821.25 0.00
P 0 0.00 0.00 0.00
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
21 38.50 2330.50 0.00
Other 0 0.00 0.00 0.00
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Total 109 122.50 5438.50 0.00