CMS/EIP Fiscal Report Center: 07
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 57 192.00 7104.00 37.00
Subtotal (Total Children Is Unduplicated) 57 192.00 7104.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.50 412.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 22.00 1221.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 64.00 4800.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 14 14.00 700.00 50.00
Subtotal (Total Children Is Unduplicated) 36 111.50 7544.50 67.66
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Total 303.50 14648.50 48.27
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Number of Children (Unduplicated) With at Least One Service 57
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Center 07
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 8 7.25 281.25 0.00
P 285 248.50 11525.50 11525.50
D 0 0.00 0.00 0.00
S 12 10.75 397.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
22 37.00 2444.00 0.00
Other 0 0.00 0.00 0.00
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Total 327 303.50 14648.50 11525.50