CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 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 499 1487.000000 54917.2500 36.9316
Subtotal (Total Children Is Unduplicated) 499 1487.000000 54917.2500 36.9316
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 26.500000 1434.7500 54.1415
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 58.500000 4387.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 118 231.500000 12792.7500 55.2603
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 91 179.500000 13462.5000 75.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 141 523.500000 34007.5000 64.9618
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 71 219.000000 10852.0000 49.5525
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 3.000000 150.0000 50.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.000000 50.0000 50.0000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 78 227.000000 11177.0000 49.2379
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Total 2237.500000 100101.7500 44.7382
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Number of Children (Unduplicated) With at Least One Service 521
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Center 53
Flag Claims Units Chgs Paid
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R 97 107.500000 4255.5000 311.0000
U 0 0.000000 0.0000 0.0000
B 1346 1296.000000 54015.7500 0.0000
P 699 834.000000 41830.5000 40180.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2142 2237.500000 100101.7500 40491.5000