CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1026 3110.250000 115079.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1026 3110.250000 115079.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.500000 1162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 52.500000 2913.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 67 180.000000 13500.0000 75.0000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 10 10.000000 500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 79 268.000000 18787.2500 70.1017
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 0.750000 37.5000 50.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 2 1.750000 87.5000 50.0000
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Total 3380.000000 133954.0000 39.6314
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Number of Children (Unduplicated) With at Least One Service 1026
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Center 07
Flag Claims Units Chgs Paid
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R 15 8.750000 323.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 144 86.250000 3191.2500 0.0000
P 4728 3285.000000 130439.0000 130429.7500
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 4887 3380.000000 133954.0000 130429.7500