CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
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 291 659.75 24410.75 37.00
Subtotal (Total Children Is Unduplicated) 291 659.75 24410.75 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.00 375.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.00 333.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 33 62.50 4687.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 37.00 2775.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 108 206.50 11460.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 75 152.50 11437.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 129 476.50 31514.25 66.14
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 3.00 75.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 65 148.50 7425.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 9.00 450.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 5 9.00 610.92 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 6.00 300.00 50.00
Subtotal (Total Children Is Unduplicated) 81 175.50 8860.92 50.49
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Total 1311.75 64785.92 49.39
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Number of Children (Unduplicated) With at Least One Service 367
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Center 53
Flag Claims Units Chgs Paid
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R 53 97.00 5347.00 0.00
U 0 0.00 0.00 0.00
B 333 362.75 16650.75 0.00
P 782 852.00 42788.17 42787.92
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
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Total 1168 1311.75 64785.92 42787.92