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:Program Patients
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 1087 1233.75 45639.50 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 944 1084.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 894 874.50 32356.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2045 6331.50 234247.00 37.00
TCON-TCON-TRANSITION CONFERENCE 252 253.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2130 9776.75 312243.00 31.94
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 143 240.25 12012.50 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 86 145.00 10875.00 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 11 16.00 1200.00 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 41 64.00 3552.00 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 426 595.00 44516.00 74.82
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 69.00 5175.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 129 180.50 13454.55 74.54
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 307 451.50 25058.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 92 119.00 8925.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 8 8.00 388.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 742 2020.75 134260.30 66.44
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.00 193.86 48.47
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 469 3534.75 176237.50 49.86
INTR-INTR-INTERPRETER 5 4.50 225.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 372 2817.75 189314.00 67.19
OCCT-97530HM-OT SESSION BY OT ASST 3 31.00 1269.52 40.95
PHY-97110-PT SESSION BY LICENSED PT 376 2415.00 160926.25 66.64
PHY-97110HM-PT SESSION BY PT ASST 15 116.75 5906.86 50.59
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 3 3.00 390.00 130.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 783 5711.00 386487.48 67.67
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 935 251740 125840.50 0.50
Subtotal (Total Children Is Unduplicated) 1345 266734 1064428.47 3.99
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Total 278531.00 1510931.77 5.42
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Number of Children (Unduplicated) With at Least One Service 2243
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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 3189 2811.50 126879.29 0.00
P 10547 163644.25 552188.41 553635.62
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 5775 100758.25 331519.54 331519.54
4730 11307.25 499908.78 1163.21
Other 3 2.00 74.00 0.00
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Total 24253 278531.00 1510931.77 886393.37