CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/15/2010 Page: 1
Payclass Filters:GR
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 98 287.75 10646.75 37.00
Subtotal (Total Children Is Unduplicated) 141 434.75 16085.75 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.00 825.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.00 277.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.50 262.50 75.00
Subtotal (Total Children Is Unduplicated) 8 23.50 1665.00 70.85
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EI Services,Class #03
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) 17 496.25 698.50 1.41
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Total 954.50 18449.25 19.33
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Number of Children (Unduplicated) With at Least One Service 144
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Center 01
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 15 299.25 608.50 608.50
D 1 2.00 150.00 0.00
S 22 20.50 758.50 0.00
H 0 0.00 0.00 0.00
T 4 69.50 108.50 108.50
597 435.25 16730.25 0.00
Other 3 128.00 93.50 0.00
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Total 642 954.50 18449.25 717.00