CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 631 2179.25 80632.25 37.00
Subtotal (Total Children Is Unduplicated) 631 2179.25 80632.25 37.00
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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 86 112.00 8400.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 89 134.50 7464.75 55.50
Subtotal (Total Children Is Unduplicated) 100 268.50 17280.75 64.36
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Total 2447.75 97913.00 40.00
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Number of Children (Unduplicated) With at Least One Service 641
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Center 57
Flag Claims Units Chgs Paid
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R 146 113.50 4199.50 0.00
U 0 0.00 0.00 0.00
B 1308 1366.50 53617.00 0.00
P 893 964.25 39939.25 39939.25
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
3 3.50 157.25 0.00
Other 0 0.00 0.00 0.00
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Total 2350 2447.75 97913.00 39939.25