CMS/EIP Fiscal Report Center: 09
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 76 158.25 5855.25 37.00
Subtotal (Total Children Is Unduplicated) 76 158.25 5855.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 63 78.50 5887.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 12.50 937.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 30.00 2250.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 71.50 3968.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 11.50 862.50 75.00
Subtotal (Total Children Is Unduplicated) 80 206.00 14036.25 68.14
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Total 364.25 19891.50 54.61
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Number of Children (Unduplicated) With at Least One Service 107
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Center 09
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 228 269.25 14489.00 0.00
P 61 78.25 4569.00 4569.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 75.00 75.00
T 0 0.00 0.00 0.00
8 15.75 758.50 0.00
Other 0 0.00 0.00 0.00
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Total 298 364.25 19891.50 4644.00