CMS/EIP Fiscal Report Center: 09
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 1035 1185.50 43854.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 944 1084.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 795 782.50 28952.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1852 5892.25 217994.75 37.00
TCON-TCON-TRANSITION CONFERENCE 252 253.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1934 9197.25 290801.50 31.62
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 137 232.75 11637.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 55.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 78 134.00 10050.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 19.50 1462.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.00 525.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 40 76.00 5700.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 62.00 3441.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 20 20.00 1110.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 276 402.50 30187.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 47.00 3525.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 72.50 5437.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 222 329.50 18287.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 67 91.00 6825.00 75.00
Subtotal (Total Children Is Unduplicated) 576 1494.75 98243.75 65.73
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 40 57.75 2887.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 2.00 50.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 9.00 450.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 8.25 412.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 92.75 4637.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 70 310.00 15500.00 50.00
INTR-INTR-INTERPRETER 5 4.50 225.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 15 79.25 5379.49 67.88
PHY-97110-PT SESSION BY LICENSED PT 19 114.25 7553.18 66.11
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 123.00 8349.24 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 259 26596.0 13268.50 0.50
Subtotal (Total Children Is Unduplicated) 282 27397.8 58762.91 2.14
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Total 38089.75 447808.16 11.76
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Number of Children (Unduplicated) With at Least One Service 1959
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Center 09
Flag Claims Units Chgs Paid
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R 8 6.75 286.75 0.00
U 0 0.00 0.00 0.00
B 2961 2542.25 112390.29 0.00
P 6890 19781.75 181856.07 181916.78
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 3709 13483.25 89921.85 89921.85
1486 2273.75 63279.20 0.00
Other 3 2.00 74.00 0.00
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Total 15057 38089.75 447808.16 271838.63