CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 787 395.00 14615.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 710 832.25 30774.75 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 2092 6205.25 229298.25 36.95
Subtotal (Total Children Is Unduplicated) 2125 7432.50 274688.00 36.96
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 34 49.50 3712.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.50 337.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.50 562.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 39 80.50 6000.00 74.53
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 16.00 888.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 237 320.50 24000.00 74.88
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 58.00 4350.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 56.50 4237.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 244 340.00 18814.50 55.34
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 129 184.50 13808.25 74.84
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 2.00 145.56 72.78
Subtotal (Total Children Is Unduplicated) 387 1119.50 76856.31 68.65
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 10 23.50 1175.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.50 75.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 17.00 850.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 862.00 431.00 0.50
Subtotal (Total Children Is Unduplicated) 18 905.00 2556.00 2.82
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Total 9457.00 354100.31 37.44
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Number of Children (Unduplicated) With at Least One Service 2130
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Center 01
Flag Claims Units Chgs Paid
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R 17 12.00 444.00 0.00
U 0 0.00 0.00 0.00
B 1584 1009.75 39316.50 277.50
P 3288 2308.00 88490.00 88368.25
D 244 237.75 12422.00 0.00
S 802 601.75 22349.50 0.00
H 11 18.50 1220.56 0.00
T 0 0.00 0.00 0.00
5922 4491.25 134991.25 0.00
Other 576 778.00 54866.50 92.50
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Total 12444 9457.00 354100.31 88738.25