CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
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 850 422.00 15614.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 767 889.25 32902.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2269 6729.00 248723.25 36.96
Subtotal (Total Children Is Unduplicated) 2292 8040.25 297239.50 36.97
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 3 8.00 400.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 9.00 675.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 17.00 1275.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.50 582.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 93 159.50 11962.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 20.50 1537.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 26.50 1987.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 75 147.50 8186.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 92.50 6937.50 75.00
Subtotal (Total Children Is Unduplicated) 149 491.00 33544.00 68.32
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 14.25 712.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 19.00 950.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 2.50 169.70 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 18 668.00 334.00 0.50
Subtotal (Total Children Is Unduplicated) 25 705.75 2266.20 3.21
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Total 9237.00 333049.70 36.06
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Number of Children (Unduplicated) With at Least One Service 2292
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Center 01
Flag Claims Units Chgs Paid
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R 247 163.25 6227.50 0.00
U 0 0.00 0.00 0.00
B 3181 2269.25 85541.75 0.00
P 1 0.25 9.25 9.25
D 221 327.50 21770.50 0.00
S 2237 1686.25 62252.50 0.00
H 2 3.50 262.50 0.00
T 0 0.00 0.00 0.00
6830 4552.00 151437.45 0.00
Other 54 235.00 5548.25 0.00
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Total 12773 9237.00 333049.70 9.25