CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
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 1035 1182.50 43743.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 944 1084.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 794 781.25 28906.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 965 3035.25 112304.25 37.00
TCON-TCON-TRANSITION CONFERENCE 252 253.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1735 6336.00 184953.75 29.19
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 143 240.25 12012.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 20.00 1500.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 15.50 860.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 63 103.00 7616.00 73.94
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.50 487.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 22.50 1604.55 71.31
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 76.00 4218.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 13.00 975.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 229 516.25 30550.80 59.18
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.00 138.96 46.32
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 91 130.25 6512.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 4.75 118.75 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 14 12.50 625.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 4 1.00 25.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 39 41.75 2087.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 37.25 1862.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 37 128.00 6400.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 223 1804.00 89700.00 49.72
INTR-INTR-INTERPRETER 5 4.50 225.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 175 1275.00 84592.13 66.35
OCCT-97530HM-OT SESSION BY OT ASST 2 19.50 644.84 33.07
PHY-97110-PT SESSION BY LICENSED PT 157 947.75 61329.32 64.71
PHY-97110HM-PT SESSION BY PT ASST 5 48.75 2213.10 45.40
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 3 3.00 390.00 130.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 507 3858.75 260756.75 67.58
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 929 251080 125510.50 0.50
Subtotal (Total Children Is Unduplicated) 1147 259400 643138.10 2.48
----------------------------------------------------------------------------------------------------------------
Total 266252.25 858642.65 3.22
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1876
----------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
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 9748 162443.00 509642.89 510146.47
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 5617 100311.75 325089.79 325089.79
438 3497.50 23909.97 1163.21
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 15803 266252.25 858642.65 836399.47