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
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 8.75 437.50 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 12.68 950.63 74.97
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 11.00 610.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.50 337.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 24 45.43 2842.63 62.57
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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 21 26.00 1300.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 15 12.25 612.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONOP-CONOP-CONSULT, OT, PHONE 4 2.25 56.25 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 8 4.00 100.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 21 77.25 3862.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 7 35.68 2421.62 67.87
PHY-97110-PT SESSION BY LICENSED PT 5 15.25 1035.17 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 65.19 4425.20 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 203 27691.0 13845.50 0.50
Subtotal (Total Children Is Unduplicated) 207 27936.6 27934.99 1.00
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Total 30308.55 94334.37 3.11
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Number of Children (Unduplicated) With at Least One Service 684
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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 1 1.00 15.00 15.00
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
4304 30303.30 94236.12 0.00
Other 0 0.00 0.00 0.00
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Total 4310 30308.55 94334.37 15.00