CMS/EIP Fiscal Report Center: 57
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 732 3032.500000 112202.5000 37.0000
Subtotal (Total Children Is Unduplicated) 732 3032.500000 112202.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 12.000000 900.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 17.000000 943.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 115 128.000000 9600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 133 195.500000 10850.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 24.500000 1837.5000 75.0000
Subtotal (Total Children Is Unduplicated) 146 380.500000 24393.7500 64.1097
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Total 3413.000000 136596.2500 40.0223
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Number of Children (Unduplicated) With at Least One Service 733
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Center 57
Flag Claims Units Chgs Paid
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R 83 88.500000 3274.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1242 1310.500000 58766.7500 0.0000
P 2071 2014.000000 74555.0000 74475.5800
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 3396 3413.000000 136596.2500 74475.5800