CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Payclass Filters:GR
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 110 287.50 10637.50 37.00
Subtotal (Total Children Is Unduplicated) 147 472.75 17491.75 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.00 750.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.00 11.61 5.81
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 30.50 1692.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 70.50 5287.50 75.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 37 117.00 7988.86 68.28
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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 2925.75 26745.11 9.14
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Number of Children (Unduplicated) With at Least One Service 148
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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 54 1415.00 3040.11 3040.11
D 0 0.00 0.00 0.00
S 6 2.00 74.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
811 1508.75 23631.00 0.00
Other 0 0.00 0.00 0.00
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Total 871 2925.75 26745.11 3040.11