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: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 219 144.50 5291.00 36.62
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 348 481.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 84 62.50 2312.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 612 1918.00 70670.00 36.85
TCON-TCON-TRANSITION CONFERENCE 35 35.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 615 2641.00 78273.50 29.64
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 4 6.00 750.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 8.00 461.00 57.63
EXIT-EXIT-TRANSITION ASSESSMENT 8 9.00 450.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 8.00 600.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.50 262.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.50 512.50 113.89
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 127 173.50 13012.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 53.00 3975.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 20.50 1537.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 47 81.00 4495.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 91 93.50 8237.50 88.10
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 6 6.00 291.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 21 22.00 1067.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 6 6.00 291.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 14.00 679.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 38 38.00 1843.00 48.50
Subtotal (Total Children Is Unduplicated) 224 550.50 38687.00 70.28
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.00 636.34 159.09
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 4.00 200.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 1.00 50.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.50 25.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 2.00 100.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 5 4.00 100.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 81 527.50 25885.00 49.07
INTR-INTR-INTERPRETER 1 4.00 180.00 45.00
OCCT-97530-OT SESSION BY LICENSED OT 105 647.25 43935.33 67.88
OCCT-97530HM-OT SESSION BY OT ASST 18 81.00 4399.92 54.32
PHY-97110-PT SESSION BY LICENSED PT 66 356.00 24165.28 67.88
PHY-97110HM-PT SESSION BY PT ASST 21 73.00 3965.36 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 323 1985.70 134789.68 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 3.00 162.96 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 4 7.00 92.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 367 85460.0 64668.80 0.76
Subtotal (Total Children Is Unduplicated) 454 89161.5 303393.57 3.40
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Total 92352.95 420354.07 4.55
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Number of Children (Unduplicated) With at Least One Service 701
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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 2 1.00 37.00 0.00
P 2734 27634.43 85311.10 85273.60
D 46 45.25 2634.25 0.00
S 1 0.50 18.50 0.00
H 9 9.00 2075.00 0.00
T 3868 60353.19 114350.62 114350.62
5501 4309.58 215927.60 0.00
Other 0 0.00 0.00 0.00
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Total 12161 92352.95 420354.07 199624.22