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:OTHER
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
CASE-CASE-NON-TCM CASE MANAGEMENT 8 3.00 111.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.25 46.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 268 695.25 25705.75 36.97
Subtotal (Total Children Is Unduplicated) 270 699.50 25863.00 36.97
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.50 562.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 21.00 1575.00 75.00
Subtotal (Total Children Is Unduplicated) 15 28.50 2137.50 75.00
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Total 728.00 28000.50 38.46
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Number of Children (Unduplicated) With at Least One Service 284
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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 0 0.00 0.00 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
863 728.00 28000.50 0.00
Other 0 0.00 0.00 0.00
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Total 863 728.00 28000.50 0.00