CMS/EIP Fiscal Report Center: 09
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 52 48.25 1785.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 99 92.00 3404.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 193 439.25 16252.25 37.00
Subtotal (Total Children Is Unduplicated) 196 579.50 21441.50 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 5.00 375.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 115 145.50 10912.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 21.00 1575.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 59.00 4425.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 76 104.00 5772.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 28.00 2100.00 75.00
Subtotal (Total Children Is Unduplicated) 137 367.50 25495.50 69.38
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 660.00 330.00 0.50
Subtotal (Total Children Is Unduplicated) 6 660.00 330.00 0.50
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Total 1607.00 47267.00 29.41
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Number of Children (Unduplicated) With at Least One Service 201
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Center 09
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 228 269.25 14489.00 0.00
P 312 679.00 14708.00 14708.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 75.00 75.00
T 158 446.50 6429.75 6429.75
185 211.25 11565.25 0.00
Other 0 0.00 0.00 0.00
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Total 884 1607.00 47267.00 21212.75