CMS/EIP Fiscal Report Center: 07
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 72 51.50 1905.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 84 115.25 4264.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 131 469.50 17371.50 37.00
Subtotal (Total Children Is Unduplicated) 131 636.25 23541.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.00 300.00 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 6 11.50 862.50 75.00
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 25 46.00 2553.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 150.50 11287.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 15 15.00 750.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 74 233.50 16175.00 69.27
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 28 1991.00 995.50 0.50
Subtotal (Total Children Is Unduplicated) 28 1991.00 995.50 0.50
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Total 2860.75 40711.75 14.23
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Number of Children (Unduplicated) With at Least One Service 131
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Center 07
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 8 7.25 281.25 0.00
P 316 1217.50 12948.50 12948.50
D 0 0.00 0.00 0.00
S 16 12.25 453.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
809 1623.75 27028.75 0.00
Other 0 0.00 0.00 0.00
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Total 1149 2860.75 40711.75 12948.50