CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/15/2012 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 73 409.000000 15096.0000 36.9095
Subtotal (Total Children Is Unduplicated) 73 409.000000 15096.0000 36.9095
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 82.500000 4578.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 79.500000 5962.5000 75.0000
Subtotal (Total Children Is Unduplicated) 49 190.000000 12446.2500 65.5066
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 10.000000 500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1 10.000000 500.0000 50.0000
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Total 609.000000 28042.2500 46.0464
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Number of Children (Unduplicated) With at Least One Service 73
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Center 53
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 95 136.750000 5337.7500 0.0000
P 238 293.250000 13062.5000 13044.0000
D 35 41.750000 1557.7500 0.0000
S 50 55.250000 2344.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
49 82.000000 5740.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 467 609.000000 28042.2500 13044.0000