CMS/EIP Fiscal Report Center: 57
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 302 208.00 7696.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 607 618.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 258 378.25 13995.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1305 4760.25 176094.25 36.99
TCON-TCON-TRANSITION CONFERENCE 138 141.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1339 6105.50 197785.50 32.39
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 3.00 150.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 55 55.00 2750.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 19.00 1425.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 21.50 1193.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 320 406.50 30487.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.50 862.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 9.00 675.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 321 491.00 27250.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.00 975.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 21 21.00 1018.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 19 19.00 921.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 12 12.00 582.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 19 44.00 2134.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 136 138.00 6693.00 48.50
Subtotal (Total Children Is Unduplicated) 561 1264.50 77192.75 61.05
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 4.00 200.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 408 622.00 31100.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 73 96.00 2400.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 4.00 200.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 26.00 1300.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 1.00 25.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 396 597.50 29875.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 69 92.00 2300.00 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 84 8672.00 78048.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 346.00 8650.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 730 5456.75 272787.50 49.99
OCCT-97530-OT SESSION BY LICENSED OT 144 577.00 39166.76 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 141 588.75 39964.35 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.00 100.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 451 2064.50 140138.26 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 11 34.00 448.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 783 140948 72515.60 0.51
Subtotal (Total Children Is Unduplicated) 1038 160135 719352.91 4.49
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Total 167504.50 994331.16 5.94
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Number of Children (Unduplicated) With at Least One Service 1565
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Center 57
Flag Claims Units Chgs Paid
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R 158 121.25 4486.25 0.00
U 0 0.00 0.00 0.00
B 1359 1396.50 54727.00 0.00
P 893 964.25 39939.25 39939.25
D 11 16.25 874.00 0.00
S 232 6209.50 12902.66 12834.78
H 0 0.00 0.00 0.00
T 4656 137396.23 337570.42 336124.85
6656 21237.02 541352.42 199750.36
Other 40 163.50 2479.16 2479.16
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Total 14005 167504.50 994331.16 591128.40