CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
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 153 80.00 2960.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 113 114.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 114 189.50 7011.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 385 852.50 31255.25 36.66
TCON-TCON-TRANSITION CONFERENCE 27 27.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 442 1263.00 41226.75 32.64
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 3.00 150.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 27 51.00 2550.00 50.00
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 2 4.00 222.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 68.50 5102.50 74.49
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 30.00 2250.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 13.00 975.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 54.00 2997.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 34.00 2550.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 52.00 26.00
Subtotal (Total Children Is Unduplicated) 87 263.50 17148.50 65.08
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 80.00 40.00
AUD-HA_FUP-AUDIOLOGY SERVICES 2 4.00 140.23 35.06
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 10.00 500.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 21 19.00 950.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 7.75 387.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 3.00 75.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 11.00 550.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.25 6.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 77 476.50 23825.00 50.00
INTR-INTR-INTERPRETER 6 38.25 675.00 17.65
OCCT-97530-OT SESSION BY LICENSED OT 24 117.25 6823.10 58.19
PHY-97110-PT SESSION BY LICENSED PT 13 65.75 4223.23 64.23
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 289.25 19404.16 67.08
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 297 77890.0 38945.00 0.50
Subtotal (Total Children Is Unduplicated) 317 78934.0 96584.47 1.22
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Total 80460.50 154959.72 1.93
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Number of Children (Unduplicated) With at Least One Service 556
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Center 02
Flag Claims Units Chgs Paid
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R 17 13.50 499.50 0.00
U 0 0.00 0.00 0.00
B 649 536.50 19637.25 0.00
P 1 0.50 18.50 0.00
D 0 0.00 0.00 0.00
S 1 1.25 46.25 0.00
H 0 0.00 0.00 0.00
T 875 45937.25 60597.95 60597.95
1577 33971.50 74160.27 0.00
Other 0 0.00 0.00 0.00
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Total 3120 80460.50 154959.72 60597.95