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:Not Part C
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 5 1.75 64.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 28 28.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 35 27.25 1008.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 38 113.00 4181.00 37.00
TCON-TCON-TRANSITION CONFERENCE 4 4.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 38 174.00 5254.00 30.20
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Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.00 111.00 55.50
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 22 40.00 2558.03 63.95
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 22.00 1803.64 81.98
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.00 600.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 51.00 3323.67 65.17
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 36.00 2932.28 81.45
Subtotal (Total Children Is Unduplicated) 34 165.50 11816.12 71.40
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 4.00 200.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 34 3335.00 1667.50 0.50
Subtotal (Total Children Is Unduplicated) 34 3339.00 1867.50 0.56
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Total 3678.50 18937.62 5.15
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Number of Children (Unduplicated) With at Least One Service 41
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Center 53
Flag Claims Units Chgs Paid
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R 6 12.00 707.00 0.00
U 0 0.00 0.00 0.00
B 37 50.50 2388.25 0.00
P 55 90.66 5426.14 5426.14
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
270 3525.34 10416.23 0.00
Other 0 0.00 0.00 0.00
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Total 368 3678.50 18937.62 5426.14