CMS/EIP Fiscal Report Center: 10
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 12 6.50 240.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 877 938.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 724 789.50 29211.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2105 7528.50 278554.50 37.00
TCON-TCON-TRANSITION CONFERENCE 236 236.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2111 9498.50 308006.50 32.43
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 33 60.50 4537.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 25.50 1912.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 16.00 1200.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 18.00 1350.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 43.50 2414.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 204 359.50 26962.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 131 232.50 17437.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 81 131.50 9862.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 197 366.00 20313.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 130 168.00 12600.00 75.00
Subtotal (Total Children Is Unduplicated) 376 1421.00 98589.75 69.38
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Total 10919.50 406596.25 37.24
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Number of Children (Unduplicated) With at Least One Service 2111
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Center 10
Flag Claims Units Chgs Paid
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R 3 1.50 55.50 0.00
U 0 0.00 0.00 0.00
B 1411 842.00 31381.00 138.75
P 6297 4258.50 181706.50 181383.76
D 54 27.75 1178.75 1178.75
S 78 54.00 1998.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
7617 5735.75 190276.50 0.00
Other 0 0.00 0.00 0.00
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Total 15460 10919.50 406596.25 182701.26