CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 1597 4786.00 176786.00 36.94
Subtotal (Total Children Is Unduplicated) 1597 4786.00 176786.00 36.94
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 33.50 2512.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 15 25.50 1912.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 17.50 971.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 156 229.00 17137.50 74.84
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 24.50 1837.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 39 53.50 4012.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 114 159.00 8824.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 89 128.00 9600.00 75.00
Subtotal (Total Children Is Unduplicated) 235 675.50 47183.25 69.85
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 15.00 750.00 50.00
Subtotal (Total Children Is Unduplicated) 2 15.00 750.00 50.00
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Total 5476.50 224719.25 41.03
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Number of Children (Unduplicated) With at Least One Service 1598
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Center 01
Flag Claims Units Chgs Paid
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R 15 7.25 306.25 0.00
U 0 0.00 0.00 0.00
B 4688 3219.75 127395.00 9.25
P 1897 1277.00 47897.00 47860.00
D 69 43.75 1618.75 0.00
S 855 665.75 28461.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
12 8.50 352.50 0.00
Other 176 254.50 18688.25 0.00
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Total 7712 5476.50 224719.25 47869.25