CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EXT
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 14 14.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 63 60.75 2247.75 37.00
TCON-TCON-TRANSITION CONFERENCE 8 8.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 63 82.75 2247.75 27.16
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Screening, Eval, and Assessment,Class #02
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) 182 234.00 11349.00 48.50
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 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 8600.00 77400.00 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 144 573.00 38895.24 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 141 586.75 39828.59 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.00 100.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 450 2054.50 139459.46 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 11 34.00 448.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 780 140169 72021.30 0.51
Subtotal (Total Children Is Unduplicated) 1034 159265 716974.53 4.50
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Total 159581.25 730571.28 4.58
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Number of Children (Unduplicated) With at Least One Service 1042
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Center 57
Flag Claims Units Chgs Paid
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R 12 7.75 286.75 0.00
U 0 0.00 0.00 0.00
B 51 30.00 1110.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 231 6124.50 12860.16 12792.28
H 0 0.00 0.00 0.00
T 4631 136750.23 336457.58 335009.01
2179 16505.27 377377.63 199750.36
Other 40 163.50 2479.16 2479.16
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Total 7144 159581.25 730571.28 550030.81