CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
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 408 255.75 9462.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 391 514.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 351 270.75 10017.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 354 1196.00 44076.25 36.85
TCON-TCON-TRANSITION CONFERENCE 89 90.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 673 2326.50 63556.75 27.32
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 6 9.75 487.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 17 18.50 850.00 45.95
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 17.18 1224.13 71.25
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 348.50 63.36
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.50 262.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 13.00 710.50 54.65
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.00 450.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.00 339.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 5.00 242.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 9 9.00 436.50 48.50
Subtotal (Total Children Is Unduplicated) 62 96.43 5476.63 56.79
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.00 45.00 15.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 65 75.75 3787.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 20 17.25 862.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.00 100.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 5 2.75 68.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 7.50 375.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 5 1.75 43.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 15.50 775.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 9 4.50 112.50 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 39 145.05 7252.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 11.00 550.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 49 248.19 16842.82 67.86
PHY-97110-PT SESSION BY LICENSED PT 38 179.14 12157.83 67.87
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.50 75.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 136 619.77 42066.29 67.87
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 496 116264 58132.00 0.50
Subtotal (Total Children Is Unduplicated) 517 117599 143258.94 1.22
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Total 120022.08 212292.32 1.77
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Number of Children (Unduplicated) With at Least One Service 706
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Center 52
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 0 0.00 0.00 0.00
P 742 37283.98 50675.90 50675.90
D 0 0.00 0.00 0.00
S 5 4.25 83.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5283 82733.85 161533.17 0.00
Other 0 0.00 0.00 0.00
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Total 6030 120022.08 212292.32 50675.90