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: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 968 962.25 35603.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 969 1114.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 865 886.75 32809.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1918 6387.50 236210.00 36.98
TCON-TCON-TRANSITION CONFERENCE 294 414.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1982 9764.50 304623.00 31.20
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 141 256.75 12837.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 51 89.00 6675.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 8.50 637.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 32 58.50 4387.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 32.50 1803.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 11 11.00 610.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 317 475.00 35625.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 60.00 4500.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 77 119.50 8912.05 74.58
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 241 386.00 21367.50 55.36
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 81 118.50 8887.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 10 10.00 485.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 12 12.00 582.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.00 194.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 9.00 436.50 48.50
Subtotal (Total Children Is Unduplicated) 585 1655.75 108353.80 65.44
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 302.08 151.04
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 116 170.50 8525.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 23 25.25 1262.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 8 4.50 112.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 24 42.75 2137.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 25.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 59.50 2975.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 2.00 50.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 99.00 4950.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 6 5.25 131.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 529 3995.75 199787.50 50.00
INTR-INTR-INTERPRETER 4 4.75 237.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 383 2929.00 195733.74 66.83
OCCT-97530HM-OT SESSION BY OT ASST 7 27.25 1195.92 43.89
PHY-97110-PT SESSION BY LICENSED PT 354 2390.75 159857.49 66.87
PHY-97110HM-PT SESSION BY PT ASST 16 119.00 5853.88 49.19
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.00 130.00 130.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 833 6898.25 465176.96 67.43
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1010 289981 144990.50 0.50
Subtotal (Total Children Is Unduplicated) 1404 306759 1193434.32 3.89
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Total 318178.75 1606411.12 5.05
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Number of Children (Unduplicated) With at Least One Service 2088
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Center 09
Flag Claims Units Chgs Paid
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R 4 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 4065 3617.25 159174.11 0.00
P 10543 191451.25 574390.77 576070.02
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 50.00 50.00
T 5656 109901.75 321117.27 321117.27
4594 13202.50 551493.97 2265.36
Other 0 0.00 0.00 0.00
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Total 24863 318178.75 1606411.12 899502.65