CMS/EIP Fiscal Report Center: 07
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 1111 907.00 33559.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 210 219.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 601 858.00 31709.50 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 1570 5284.25 195480.25 36.99
TCON-TCON-TRANSITION CONFERENCE 39 39.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1618 7307.25 260748.75 35.68
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 0.75 37.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 8 19.00 950.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 22.00 1650.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.00 444.00 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 50.00 2775.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 133 421.50 31612.50 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.00 145.56 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 5 5.25 262.50 50.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 37 37.00 1850.00 50.00
Subtotal (Total Children Is Unduplicated) 183 565.50 39727.06 70.25
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 0.75 37.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 1.50 75.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 5 2.75 68.75 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 12.75 637.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 61 3820.00 1877.50 0.49
Subtotal (Total Children Is Unduplicated) 73 3838.75 2746.25 0.72
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Total 11711.50 303222.06 25.89
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Number of Children (Unduplicated) With at Least One Service 1618
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Center 07
Flag Claims Units Chgs Paid
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R 3 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 87 49.00 1870.00 0.00
P 4743 3037.75 122738.75 122626.25
D 14 6.75 249.75 0.00
S 111 54.25 1998.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8738 8561.75 176291.56 0.00
Other 0 0.00 0.00 0.00
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Total 13696 11711.50 303222.06 122626.25