CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 1143 913.75 33808.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 202 207.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 659 941.25 34752.25 36.92
TCM-T1017TL-TARGETED CASE MANAGEMENT 811 2154.25 79670.25 36.98
TCON-TCON-TRANSITION CONFERENCE 39 39.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1471 4255.25 148231.25 34.83
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 7 13.25 662.50 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.00 600.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 38 75.50 4190.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 210.50 15787.50 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 3.75 187.50 50.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 100 321.00 22040.87 68.66
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EI Services,Class #03
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 2.50 125.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 0.75 18.75 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 13 6.00 300.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 85 4636.00 2303.00 0.50
Subtotal (Total Children Is Unduplicated) 92 4646.75 2809.25 0.60
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Total 9223.00 173081.37 18.77
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Number of Children (Unduplicated) With at Least One Service 1473
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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 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 9 4.00 148.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8602 9219.00 172933.37 0.00
Other 0 0.00 0.00 0.00
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Total 8611 9223.00 173081.37 0.00