CMS/EIP Fiscal Report Center: 55
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 30 13.00 481.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 47 54.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 12 6.00 222.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 77 339.25 12478.25 36.78
Subtotal (Total Children Is Unduplicated) 77 412.25 13181.25 31.97
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 4.00 200.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 53.97 4047.56 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 18.50 1387.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 13.50 1012.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 22.00 1221.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 39.00 4462.50 114.42
Subtotal (Total Children Is Unduplicated) 57 152.97 12481.06 81.59
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Total 565.22 25662.31 45.40
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Number of Children (Unduplicated) With at Least One Service 77
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Center 55
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 3 3.50 129.50 0.00
P 164 181.00 7897.50 7810.00
D 9 9.75 702.75 0.00
S 0 0.00 0.00 0.00
H 8 8.00 2000.00 0.00
T 18 25.47 1754.06 1754.06
316 337.50 13178.50 0.00
Other 0 0.00 0.00 0.00
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Total 518 565.22 25662.31 9564.06