CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Payclass Filters:TPIN
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 4 4.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 1.75 64.75 37.00
Subtotal (Total Children Is Unduplicated) 6 5.75 64.75 11.26
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 42.50 3187.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 34.00 2550.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.50 360.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 102 143.50 10800.00 75.26
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.00 600.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 52.00 3937.50 75.72
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 48 67.50 3746.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 73.00 5475.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 136 439.00 31318.50 71.34
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 25.00 1250.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 123 611.50 41508.62 67.88
PHY-97110-PT SESSION BY LICENSED PT 121 644.00 43714.72 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 14.00 760.48 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 165 779.25 52895.49 67.88
Subtotal (Total Children Is Unduplicated) 279 2073.75 140129.31 67.57
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Total 2518.50 171512.56 68.10
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Number of Children (Unduplicated) With at Least One Service 386
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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 0 0.00 0.00 0.00
P 35 25.25 1728.21 3313.12
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1636 2493.25 169784.35 193.73
Other 0 0.00 0.00 0.00
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Total 1671 2518.50 171512.56 3506.85