CMS/EIP Fiscal Report Center: 09
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 42 27.25 1008.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 136 98.50 3644.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 288 704.50 26066.50 37.00
Subtotal (Total Children Is Unduplicated) 290 830.25 30719.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 13.50 1012.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 9.00 499.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 187 241.00 18150.00 75.31
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 44.50 3337.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 52.50 3937.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 160 228.50 12681.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 44.00 3300.00 75.00
Subtotal (Total Children Is Unduplicated) 229 640.50 43481.25 67.89
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 19 1485.00 742.50 0.50
Subtotal (Total Children Is Unduplicated) 19 1485.00 742.50 0.50
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Total 2955.75 74943.00 25.35
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Number of Children (Unduplicated) With at Least One Service 308
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Center 09
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 497 670.75 34970.75 0.00
P 358 901.00 15208.00 15208.00
D 0 0.00 0.00 0.00
S 2 3.00 195.75 0.00
H 0 0.00 0.00 0.00
T 213 1117.75 8956.50 8956.50
206 263.25 15612.00 0.00
Other 0 0.00 0.00 0.00
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Total 1276 2955.75 74943.00 24164.50