CMS/EIP Fiscal Report Center: 53
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 92 35.00 1295.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 242 249.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 261 217.75 8056.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 172 310.00 11470.00 37.00
TCON-TCON-TRANSITION CONFERENCE 24 25.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 389 836.75 20821.75 24.88
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 56 108.00 5400.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 5.50 305.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.50 249.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 68 128.24 7117.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.00 750.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 14.95 1121.60 75.02
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.00 1200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 36.58 2030.60 55.51
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 31.51 2363.60 75.01
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.50 75.00 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 144 364.28 21096.30 57.91
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 81 95.75 4787.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 18 12.00 300.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 6.50 325.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.00 250.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 6.00 150.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 49.00 2450.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 3.00 150.00 50.00
INTR-INTR-INTERPRETER 8 20.00 1000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 7 17.63 1196.64 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 338 27988.0 13994.00 0.50
Subtotal (Total Children Is Unduplicated) 354 28204.6 24671.89 0.87
----------------------------------------------------------------------------------------------------------------
Total 29405.66 66589.94 2.26
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 469
----------------------------------------------------------------------------------------------------------------
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
2279 29405.66 66589.94 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2279 29405.66 66589.94 0.00