CMS/EIP Fiscal Report Center: 57
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 663 2350.75 86977.75 37.00
Subtotal (Total Children Is Unduplicated) 663 2350.75 86977.75 37.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 10.00 750.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 12.00 666.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 99 127.50 9562.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 101 149.50 8297.25 55.50
Subtotal (Total Children Is Unduplicated) 112 299.00 19275.75 64.47
----------------------------------------------------------------------------------------------------------------
Total 2649.75 106253.50 40.10
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 675
----------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 167 133.00 4921.00 0.00
U 0 0.00 0.00 0.00
B 1436 1506.75 59324.50 0.00
P 927 1010.00 42008.00 42008.00
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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2530 2649.75 106253.50 42008.00