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:EIP DEI DEIP
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 594 604.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 258 378.25 13995.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1293 4699.50 173846.50 36.99
TCON-TCON-TRANSITION CONFERENCE 130 133.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1328 6022.75 195537.75 32.47
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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
Subtotal (Total Children Is Unduplicated) 405 1030.50 65843.75 63.90
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.00 150.00 50.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 72.00 648.00 9.00
OCCT-97530-OT SESSION BY LICENSED OT 1 4.00 271.52 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 2.00 135.76 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 10.00 678.80 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 12 779.00 494.30 0.63
Subtotal (Total Children Is Unduplicated) 17 870.00 2378.38 2.73
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Total 7923.25 263759.88 33.29
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Number of Children (Unduplicated) With at Least One Service 1338
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Center 57
Flag Claims Units Chgs Paid
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R 146 113.50 4199.50 0.00
U 0 0.00 0.00 0.00
B 1308 1366.50 53617.00 0.00
P 893 964.25 39939.25 39939.25
D 11 16.25 874.00 0.00
S 1 85.00 42.50 42.50
H 0 0.00 0.00 0.00
T 25 646.00 1112.84 1115.84
4477 4731.75 163974.79 0.00
Other 0 0.00 0.00 0.00
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Total 6861 7923.25 263759.88 41097.59