CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
Eligibility Filter:Not Part C
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 38 19.00 703.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 108 128.00 4736.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 164 639.75 23633.75 36.94
Subtotal (Total Children Is Unduplicated) 164 786.75 29072.75 36.95
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 36.00 2700.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 15.00 1125.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.00 600.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 33.00 1831.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 24.00 1800.00 75.00
Subtotal (Total Children Is Unduplicated) 38 122.00 8467.50 69.41
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 4.00 200.00 50.00
INTR-INTR-INTERPRETER 10 14.25 457.50 32.11
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 12 482.00 241.00 0.50
Subtotal (Total Children Is Unduplicated) 18 500.25 898.50 1.80
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Total 1409.00 38438.75 27.28
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Number of Children (Unduplicated) With at Least One Service 164
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Center 01
Flag Claims Units Chgs Paid
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R 10 11.00 545.75 0.00
U 0 0.00 0.00 0.00
B 230 205.00 7838.75 0.00
P 16 301.75 701.00 608.50
D 36 65.00 4603.50 0.00
S 183 153.25 5670.25 0.00
H 2 3.50 262.50 0.00
T 4 69.50 108.50 108.50
625 459.50 17755.50 0.00
Other 11 140.50 953.00 0.00
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Total 1117 1409.00 38438.75 717.00