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
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 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 899 3139.00 116143.00 37.00
TCON-TCON-TRANSITION CONFERENCE 236 236.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1546 5109.00 145595.00 28.50
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.50 862.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.00 375.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.50 187.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.50 527.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 72.00 5400.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 41.50 3112.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 18.00 1350.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 53.50 2969.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 24.50 1837.50 75.00
Subtotal (Total Children Is Unduplicated) 61 240.00 16771.50 69.88
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Total 5349.00 162366.50 30.35
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Number of Children (Unduplicated) With at Least One Service 1546
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Center 10
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 0 0.00 0.00 0.00
D 54 27.75 1178.75 1178.75
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
7388 5321.25 161187.75 0.00
Other 0 0.00 0.00 0.00
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Total 7442 5349.00 162366.50 1178.75