CMS/EIP Fiscal Report Center: 52
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 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 702 2339.25 86228.50 36.86
TCON-TCON-TRANSITION CONFERENCE 89 90.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 716 3469.75 105709.00 30.47
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 6 8.75 437.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.50 337.50 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 5 7.00 388.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 64.00 4800.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.00 675.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 11.50 862.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 66 107.00 5938.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 26.00 1950.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 8 8.00 400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 119 261.75 16645.00 63.59
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.00 60.00 15.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 22 27.00 1350.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 15 12.50 625.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONOP-CONOP-CONSULT, OT, PHONE 4 2.75 68.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.75 37.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 3.75 187.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 9 5.00 125.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 66 242.75 12137.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 16 116.97 8094.69 69.20
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 14 62.50 4242.50 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 62 280.00 19138.25 68.35
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 203 27734.0 13867.00 0.50
Subtotal (Total Children Is Unduplicated) 208 28494.7 60071.42 2.11
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Total 32226.22 182425.42 5.66
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Number of Children (Unduplicated) With at Least One Service 721
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Center 52
Flag Claims Units Chgs Paid
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R 234 178.00 9026.76 0.00
U 0 0.00 0.00 0.00
B 880 565.00 26349.47 0.00
P 1208 689.92 26340.47 26340.47
D 0 0.00 0.00 0.00
S 72 56.50 1942.50 0.00
H 56 108.50 7493.97 0.00
T 0 0.00 0.00 0.00
4485 30628.30 111272.25 0.00
Other 0 0.00 0.00 0.00
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Total 6935 32226.22 182425.42 26340.47