CMS/EIP Fiscal Report Center: 10
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 10 8.00 296.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 800 902.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 733 819.50 30321.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2056 7153.75 264688.75 37.00
TCON-TCON-TRANSITION CONFERENCE 196 197.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2061 9080.25 295306.25 32.52
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 26.50 1987.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 20.00 1500.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 15 26.00 1950.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.00 825.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 22 42.00 2331.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 165 283.00 21225.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 116 215.50 16162.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 88 152.00 11400.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 186 351.50 19508.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 101 125.50 9412.50 75.00
Subtotal (Total Children Is Unduplicated) 336 1253.00 86301.75 68.88
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Total 10333.25 381608.00 36.93
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Number of Children (Unduplicated) With at Least One Service 2062
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Center 10
Flag Claims Units Chgs Paid
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R 607 359.00 13396.00 0.00
U 0 0.00 0.00 0.00
B 5946 3781.25 149615.00 0.00
P 502 492.50 27968.75 27913.25
D 41 22.00 909.00 899.75
S 118 64.00 2368.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
7460 5614.50 187351.25 0.00
Other 0 0.00 0.00 0.00
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Total 14674 10333.25 381608.00 28813.00