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
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 14 14.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 20 18.50 684.50 37.00
TCON-TCON-TRANSITION CONFERENCE 8 8.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 29 40.50 684.50 16.90
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Screening, Eval, and Assessment,Class #02
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 14.00 679.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 10 10.00 485.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 28.00 1358.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 71 70.48 3418.50 48.50
Subtotal (Total Children Is Unduplicated) 87 126.48 6134.50 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 403 614.00 30700.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 73 94.00 2350.00 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 13 25.00 1250.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 1.00 25.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 392 591.50 29575.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 69 90.00 2250.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 336 2425.25 121212.50 49.98
OCCT-97530-OT SESSION BY LICENSED OT 24 72.00 4887.36 67.88
PHY-97110-PT SESSION BY LICENSED PT 24 70.75 4802.51 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 255 1098.75 74583.15 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 744 137774 70823.80 0.51
Subtotal (Total Children Is Unduplicated) 882 142862 342734.32 2.40
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Total 143029.23 349553.32 2.44
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Number of Children (Unduplicated) With at Least One Service 919
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Center 57
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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 224 6113.00 12171.94 12171.94
H 0 0.00 0.00 0.00
T 4626 136722.73 335978.38 334529.81
54 191.50 1304.50 300.00
Other 3 2.00 98.50 98.50
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Total 4907 143029.23 349553.32 347100.25