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
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 67 270.000000 9990.0000 37.0000
Subtotal (Total Children Is Unduplicated) 67 270.000000 9990.0000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 17.500000 1312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 48 95.000000 5217.0000 54.9158
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 43 115.500000 8587.5000 74.3506
Subtotal (Total Children Is Unduplicated) 57 257.000000 17184.7500 66.8667
-----------------------------------------------------------------------------------------------------------------------
Total 527.000000 27174.7500 51.5650
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 67
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 14 20.250000 786.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 183 210.500000 9233.7500 0.0000
P 133 205.250000 10734.7500 9872.2500
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
46 91.000000 6420.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 376 527.000000 27174.7500 9872.2500