CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 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 542 1573.000000 58201.0000 37.0000
Subtotal (Total Children Is Unduplicated) 542 1573.000000 58201.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 8.000000 600.0000 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 7 11.500000 638.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 121 154.500000 11587.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 153 240.500000 13347.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 50 71.500000 5362.5000 75.0000
Subtotal (Total Children Is Unduplicated) 173 489.500000 31798.5000 64.9612
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Total 2062.500000 89999.5000 43.6361
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Number of Children (Unduplicated) With at Least One Service 568
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Center 57
Flag Claims Units Chgs Paid
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R 2 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1152 1090.250000 45684.7500 0.0000
P 872 971.250000 44277.7500 44277.7500
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 2026 2062.500000 89999.5000 44277.7500