CMS/EIP Fiscal Report Center: 05
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
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 261 114.50 4236.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 337 413.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 373 365.00 13505.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 713 2680.25 99150.75 36.99
Subtotal (Total Children Is Unduplicated) 716 3572.75 116892.25 32.72
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 30 51.25 2562.50 50.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.00 555.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 15 23.50 1304.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 23.00 1725.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.50 712.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 16.00 1200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 70.00 3885.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 26.00 1950.00 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.00 145.56 72.78
MED-99215-OUTPATIENT VISIT, EST, 40 MINS 1 1.00 50.15 50.15
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 12.00 436.50 36.38
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 3 3.00 150.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 134 260.25 15359.96 59.02
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 47 50.75 2537.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 258 244.50 12225.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 24 9.00 225.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 50 25.00 1250.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 91 51.25 2562.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.25 6.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 127 123.25 6162.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 5 1.50 37.50 25.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 13 41.25 962.63 23.34
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 15.25 353.99 23.21
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 86 274.00 12173.62 44.43
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 262 1448.00 72290.32 49.92
INTR-INTR-INTERPRETER 8 56.75 2837.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 63 160.46 10499.13 65.43
OCCT-97530HM-OT SESSION BY OT ASST 4 3.50 190.12 54.32
PHY-97110-PT SESSION BY LICENSED PT 90 362.93 20983.90 57.82
PHY-97110HM-PT SESSION BY PT ASST 1 0.50 27.16 54.32
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 157 471.00 31564.20 67.02
SPL-92508-GROUP SPL SESSION PER CHILD 2 39.00 514.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 421 92309.0 46154.50 0.50
Subtotal (Total Children Is Unduplicated) 481 95689.6 223608.06 2.34
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Total 99522.64 355860.27 3.58
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Number of Children (Unduplicated) With at Least One Service 719
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Center 05
Flag Claims Units Chgs Paid
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R 58 29.00 1073.00 0.00
U 0 0.00 0.00 0.00
B 2202 1196.25 44279.75 0.00
P 1037 22547.09 43212.60 43212.60
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8314 75750.30 267294.92 0.00
Other 0 0.00 0.00 0.00
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Total 11611 99522.64 355860.27 43212.60