CMS/EIP Fiscal Report Center: 02
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 308 638.50 23310.00 36.51
Subtotal (Total Children Is Unduplicated) 308 638.50 23310.00 36.51
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
Subtotal (Total Children Is Unduplicated) 2 7.50 533.25 71.10
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Total 646.00 23843.25 36.91
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Number of Children (Unduplicated) With at Least One Service 308
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Center 02
Flag Claims Units Chgs Paid
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R 10 4.75 175.75 0.00
U 0 0.00 0.00 0.00
B 731 592.00 21719.00 0.00
P 2 1.00 37.00 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
36 48.25 1911.50 0.00
Other 0 0.00 0.00 0.00
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Total 779 646.00 23843.25 0.00