CMS/EIP Fiscal Report Center: 07
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 71 39.50 1461.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 73 108.25 4005.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 142 412.75 15271.75 37.00
Subtotal (Total Children Is Unduplicated) 150 561.50 20738.50 36.93
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 4.00 300.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 14.50 1079.24 74.43
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 6.00 450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 50.00 2775.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 83.00 6225.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 10 10.00 500.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 57 174.00 11790.24 67.76
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 1.25 62.50 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 30 1578.00 789.00 0.50
Subtotal (Total Children Is Unduplicated) 33 1579.25 851.50 0.54
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Total 2314.75 33380.24 14.42
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Number of Children (Unduplicated) With at Least One Service 150
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Center 07
Flag Claims Units Chgs Paid
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R 12 9.00 333.00 0.00
U 0 0.00 0.00 0.00
B 254 225.25 9500.50 0.00
P 56 983.50 3560.24 3560.24
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
626 1097.00 19986.50 0.00
Other 0 0.00 0.00 0.00
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Total 948 2314.75 33380.24 3560.24