CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Eligibility Filter:DEI Only
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 66 25.75 945.50 36.72
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 48 46.00 1702.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 199 435.25 16104.25 37.00
Subtotal (Total Children Is Unduplicated) 201 507.00 18751.75 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.00 222.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 28.50 2137.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 5.00 375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 24.00 1332.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 2.50 187.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 32 71.50 4790.00 66.99
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 5.00 250.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.00 50.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 12.00 600.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 78.00 3900.00 50.00
INTR-INTR-INTERPRETER 3 3.25 97.50 30.00
OCCT-97530-OT SESSION BY LICENSED OT 1 5.00 339.40 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 12.00 814.56 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 4.00 200.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 4.00 271.52 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.50 27.16 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.00 52.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 24 3356.00 1678.00 0.50
Subtotal (Total Children Is Unduplicated) 29 3485.25 8293.44 2.38
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Total 4063.75 31835.19 7.83
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Number of Children (Unduplicated) With at Least One Service 203
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Center 01
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 301 213.00 8283.25 0.00
P 159 1117.00 4265.25 4265.25
D 15 13.75 788.75 0.00
S 76 56.50 2185.50 0.00
H 52 1170.50 1226.00 1151.00
T 45 1196.25 1377.50 1377.50
317 240.25 10040.68 0.00
Other 57 56.50 3668.26 0.00
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Total 1022 4063.75 31835.19 6793.75