CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
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
CASE-CASE-NON-TCM CASE MANAGEMENT 65 30.75 1137.75 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 10.75 397.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 79 177.25 6558.25 37.00
Subtotal (Total Children Is Unduplicated) 114 218.75 8093.75 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.00 166.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 21.50 1612.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 12.50 937.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 60.50 3357.75 55.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 57 71.00 3550.00 50.00
Subtotal (Total Children Is Unduplicated) 88 171.50 9849.25 57.43
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Total 390.25 17943.00 45.98
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Number of Children (Unduplicated) With at Least One Service 132
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Center 03
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 1 2.00 150.00 150.00
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 242 225.00 10273.00 10273.00
179 163.25 7520.00 0.00
Other 0 0.00 0.00 0.00
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Total 422 390.25 17943.00 10423.00