CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
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 92 275.50 10193.50 37.00
Subtotal (Total Children Is Unduplicated) 113 442.25 16363.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 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 13 24.00 1332.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 86.50 6487.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 38 120.00 8480.50 70.67
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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 2553.25 25839.25 10.12
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Number of Children (Unduplicated) With at Least One Service 114
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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 0 0.00 0.00 0.00
P 31 969.00 1423.00 1423.00
D 0 0.00 0.00 0.00
S 4 1.50 55.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
784 1582.75 24360.75 0.00
Other 0 0.00 0.00 0.00
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Total 819 2553.25 25839.25 1423.00