CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 1060 921.75 34086.25 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 820 1039.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 765 797.00 29489.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 950 2628.50 97217.50 36.99
TCON-TCON-TRANSITION CONFERENCE 200 200.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1717 5586.25 160792.75 28.78
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 55 93.50 4675.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 14.00 1050.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.50 187.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.50 187.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 9.00 499.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 55 100.50 7537.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 24.00 1800.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 16.00 1200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 80.00 4440.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
Subtotal (Total Children Is Unduplicated) 127 348.00 22027.00 63.30
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 631.90 631.90
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 76 95.75 4787.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 1.00 25.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 15.00 750.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 29.00 1450.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 2 0.75 18.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 18.25 912.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 66.50 3325.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 38 179.50 8975.00 50.00
INTR-INTR-INTERPRETER 11 15.00 750.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 13 36.50 1975.98 54.14
PHY-97110-PT SESSION BY LICENSED PT 10 45.50 2803.54 61.62
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 57.00 3869.16 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 232 27753.0 13876.50 0.50
Subtotal (Total Children Is Unduplicated) 258 28313.8 44150.83 1.56
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Total 34248.00 226970.58 6.63
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Number of Children (Unduplicated) With at Least One Service 1743
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Center 09
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 1 1.75 64.75 0.00
P 6028 21263.25 138875.29 139100.97
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 3402 11633.00 79114.65 79114.65
385 1350.00 8915.89 0.00
Other 0 0.00 0.00 0.00
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Total 9816 34248.00 226970.58 218215.62