CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Eligibility Filter:DEI Only
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 48 26.50 980.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 35 33.25 1230.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 182 431.50 15956.25 36.98
Subtotal (Total Children Is Unduplicated) 187 491.25 18167.00 36.98
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.00 150.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 16.00 1200.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 18.00 1350.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 14.00 777.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 23.00 1725.00 75.00
Subtotal (Total Children Is Unduplicated) 38 75.00 5352.00 71.36
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 3.50 175.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 3.25 162.50 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 12.00 600.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 97.00 4850.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 3.00 203.64 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 12.00 814.56 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 5.50 373.34 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.00 52.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 18 3902.00 1951.00 0.50
Subtotal (Total Children Is Unduplicated) 20 4043.25 9232.84 2.28
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Total 4609.50 32751.84 7.11
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Number of Children (Unduplicated) With at Least One Service 192
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Center 01
Flag Claims Units Chgs Paid
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R 13 7.75 286.75 0.00
U 0 0.00 0.00 0.00
B 123 86.25 3220.00 0.00
P 345 2323.00 10254.00 10254.00
D 16 13.75 802.50 0.00
S 43 30.25 1119.25 0.00
H 1 1.00 75.00 0.00
T 32 1408.50 1372.50 1372.50
318 295.00 10427.91 0.00
Other 76 444.00 5193.93 0.00
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Total 967 4609.50 32751.84 11626.50