CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
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 14 34.50 1276.50 37.00
TCON-TCON-TRANSITION CONFERENCE 4 4.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 38 95.50 2349.50 24.60
----------------------------------------------------------------------------------------------------------------
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 20 35.02 1943.71 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 0.41 30.45 74.27
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 3.41 255.45 74.91
Subtotal (Total Children Is Unduplicated) 22 47.84 2787.61 58.27
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
Total 3482.34 7004.61 2.01
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 41
----------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
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 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
233 3482.34 7004.61 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 233 3482.34 7004.61 0.00