CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Agency Filter:EIP DEI DEIP
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 968 1113.00 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 9763.50 304623.00 31.20
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 132 242.50 12125.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 50 88.00 6600.00 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 4 7.50 562.50 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 285 431.00 32287.50 74.91
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 41 69.50 5212.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 226 356.50 19730.25 55.34
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 81 118.50 8887.50 75.00
Subtotal (Total Children Is Unduplicated) 549 1481.00 97119.50 65.58
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 47 61.50 3075.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 3.00 150.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 11.00 550.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 18.50 925.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 86.00 4300.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 80 332.50 16625.00 50.00
INTR-INTR-INTERPRETER 4 4.75 237.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 12 79.25 5379.49 67.88
PHY-97110-PT SESSION BY LICENSED PT 18 80.50 5434.34 67.51
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 159.75 10588.83 66.28
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 261 29166.0 14583.00 0.50
Subtotal (Total Children Is Unduplicated) 269 30002.8 61848.16 2.06
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Total 41247.25 463590.66 11.24
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Number of Children (Unduplicated) With at Least One Service 2010
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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 6976 24264.00 167740.26 167834.60
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 3572 11651.50 82706.36 82706.36
1143 1708.50 53734.93 0.00
Other 0 0.00 0.00 0.00
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Total 15761 41247.25 463590.66 250590.96