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
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
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 137 232.75 11637.50 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 56 92.50 6937.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 13.50 1012.50 75.00
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
Subtotal (Total Children Is Unduplicated) 212 481.25 28490.75 59.20
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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 30 135.00 6750.00 50.00
INTR-INTR-INTERPRETER 5 4.50 225.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 2 2.00 135.76 67.88
PHY-97110-PT SESSION BY LICENSED PT 7 35.00 2173.69 62.11
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 84.00 5701.92 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 259 26596.0 13268.50 0.50
Subtotal (Total Children Is Unduplicated) 282 27027.3 36742.37 1.36
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Total 33844.50 250186.87 7.39
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Number of Children (Unduplicated) With at Least One Service 1767
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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 0 0.00 0.00 0.00
P 6427 19271.75 154836.52 154897.23
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
262 1089.50 5428.50 0.00
Other 0 0.00 0.00 0.00
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Total 10398 33844.50 250186.87 244819.08