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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 302 207.50 7677.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 592 602.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 258 378.25 13995.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 656 2393.75 88533.75 36.99
TCON-TCON-TRANSITION CONFERENCE 130 133.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1059 3714.50 110206.50 29.67
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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 4 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 5.00 277.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 166 212.00 15900.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 164 254.00 14097.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.00 450.00 75.00
Subtotal (Total Children Is Unduplicated) 231 548.00 34599.50 63.14
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.00 150.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 8.00 543.04 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 12 759.00 480.30 0.63
Subtotal (Total Children Is Unduplicated) 16 770.00 1173.34 1.52
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Total 5032.50 145979.34 29.01
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Number of Children (Unduplicated) With at Least One Service 1080
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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 11 16.25 874.00 0.00
S 1 85.00 42.50 42.50
H 0 0.00 0.00 0.00
T 24 626.00 1098.84 1101.84
4159 4305.25 143964.00 0.00
Other 0 0.00 0.00 0.00
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Total 4195 5032.50 145979.34 1144.34