CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Eligibility Filter:DEI Only
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.50 18.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 5 15.25 564.25 37.00
Subtotal (Total Children Is Unduplicated) 5 15.75 582.75 37.00
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Screening, Eval, and Assessment,Class #02
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 1 1.00 48.50 48.50
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 15.75 1069.11 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 4.50 244.44 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 5.25 356.37 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 309.00 154.50 0.50
Subtotal (Total Children Is Unduplicated) 1 334.50 1824.42 5.45
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Total 351.25 2455.67 6.99
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Number of Children (Unduplicated) With at Least One Service 5
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Center 51
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 14 8.00 296.00 0.00
P 17 335.50 1872.92 1872.92
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 0 0.00 0.00 0.00
13 7.75 286.75 0.00
Other 0 0.00 0.00 0.00
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Total 44 351.25 2455.67 1872.92