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:Not Part C
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 75 34.75 1285.75 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 161 188.25 6965.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 239 881.75 32495.25 36.85
Subtotal (Total Children Is Unduplicated) 239 1104.75 40746.25 36.88
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 4.00 200.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 122 154.00 11550.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 18.50 1387.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 21.00 1575.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 117 151.50 8408.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 58.50 4387.50 75.00
Subtotal (Total Children Is Unduplicated) 150 413.50 27919.25 67.52
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.00 100.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 7.00 350.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 24.00 1200.00 50.00
INTR-INTR-INTERPRETER 13 35.75 1072.50 30.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 20.50 1391.54 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 19 2622.00 1311.00 0.50
Subtotal (Total Children Is Unduplicated) 24 2711.25 5425.04 2.00
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Total 4229.50 74090.54 17.52
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Number of Children (Unduplicated) With at Least One Service 241
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Center 01
Flag Claims Units Chgs Paid
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R 7 2.75 101.75 0.00
U 0 0.00 0.00 0.00
B 238 176.25 6859.25 0.00
P 450 1448.50 13914.75 13914.75
D 39 44.50 2626.75 0.00
S 88 70.00 2590.00 0.00
H 3 6.00 400.00 0.00
T 36 1495.25 1522.00 1522.00
871 641.25 25091.54 0.00
Other 232 345.00 20984.50 0.00
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Total 1964 4229.50 74090.54 15436.75