CMS/EIP Fiscal Report Center: 53
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 0.75 27.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 7 7.50 277.50 37.00
Subtotal (Total Children Is Unduplicated) 7 10.25 305.25 29.78
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 5.50 305.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.50 262.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.50 194.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 4 19.50 1154.50 59.21
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.00 100.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.75 43.75 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 11.00 550.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 26.00 1300.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 6.00 300.00 50.00
INTR-INTR-INTERPRETER 2 5.00 250.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 3.00 150.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 2480.00 1240.00 0.50
Subtotal (Total Children Is Unduplicated) 8 2534.75 3933.75 1.55
----------------------------------------------------------------------------------------------------------------
Total 2564.50 5393.50 2.10
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12
----------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 8 11.25 607.25 0.00
P 12 10.25 527.00 527.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 13 620.00 630.00 630.00
T 7 488.00 392.50 392.50
70 1435.00 3236.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 110 2564.50 5393.50 1549.50