CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Payclass Filters:MED
Eligibility Filter:Not Part C
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 69 232.25 8593.25 37.00
Subtotal (Total Children Is Unduplicated) 69 232.25 8593.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.50 262.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.00 300.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.00 225.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 24.00 1332.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 60.50 4537.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 12 12.00 600.00 50.00
Subtotal (Total Children Is Unduplicated) 37 107.00 7257.00 67.82
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Total 339.25 15850.25 46.72
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Number of Children (Unduplicated) With at Least One Service 69
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Center 07
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 334 304.50 13875.25 13875.25
D 0 0.00 0.00 0.00
S 18 10.75 397.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
16 24.00 1577.25 0.00
Other 0 0.00 0.00 0.00
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Total 368 339.25 15850.25 13875.25