CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Eligibility Filter:Not Part C
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 87 55.25 2044.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 97 130.00 4810.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 156 519.75 19230.75 37.00
Subtotal (Total Children Is Unduplicated) 157 705.00 26085.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 15.50 1162.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.00 600.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 5.00 236.61 47.32
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 54.50 3024.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 131.00 9825.00 75.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 12 12.00 600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 74 228.00 15545.86 68.18
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 35 2334.00 1164.50 0.50
Subtotal (Total Children Is Unduplicated) 36 2336.00 1264.50 0.54
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Total 3269.00 42895.36 13.12
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Number of Children (Unduplicated) With at Least One Service 158
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Center 07
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 388 1719.50 16915.36 16915.36
D 0 0.00 0.00 0.00
S 24 12.75 471.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
829 1536.75 25508.25 0.00
Other 0 0.00 0.00 0.00
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Total 1241 3269.00 42895.36 16915.36