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: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 1229.50 45482.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 944 1084.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 893 872.75 32291.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1049 3225.75 119352.75 37.00
TCON-TCON-TRANSITION CONFERENCE 252 253.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1887 6665.00 197126.75 29.58
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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 78 127.50 9453.50 74.15
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 10.50 787.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 34.50 2504.55 72.60
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 56 93.00 5161.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 14.50 1087.50 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) 247 575.25 34644.30 60.22
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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 935 251740 125840.50 0.50
Subtotal (Total Children Is Unduplicated) 1153 260060 643468.10 2.47
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Total 267300.25 875239.15 3.27
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Number of Children (Unduplicated) With at Least One Service 2028
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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 9999 163043.75 519781.89 520285.47
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 5775 100758.25 331519.54 331519.54
440 3498.25 23937.72 1163.21
Other 0 0.00 0.00 0.00
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Total 16214 267300.25 875239.15 852968.22