CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2012 ending 09/30/2012 Date of Report:11/16/2012 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 532 2226.500000 81792.5000 36.7359
Subtotal (Total Children Is Unduplicated) 532 2226.500000 81792.5000 36.7359
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 38.000000 2850.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 53.500000 2969.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 78 151.000000 8380.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 40.000000 3000.0000 75.0000
Subtotal (Total Children Is Unduplicated) 113 310.000000 19262.2500 62.1363
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 5.000000 125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 111 517.250000 25837.5000 49.9517
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 10.750000 537.5000 50.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 22.000000 1100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 124 555.000000 27600.0000 49.7297
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Total 3091.500000 128654.7500 41.6156
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Number of Children (Unduplicated) With at Least One Service 538
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Center 53
Flag Claims Units Chgs Paid
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R 1 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 289 251.500000 10736.7500 9.2500
P 2977 2838.500000 117862.5000 117794.0000
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 3267 3091.500000 128654.7500 117803.2500