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
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 968 959.75 35510.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 964 1109.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 864 885.25 32754.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 945 3107.00 114894.25 36.98
TCON-TCON-TRANSITION CONFERENCE 294 414.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1769 6475.00 183159.25 28.29
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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 6 10.50 787.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.50 262.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.00 555.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 80.00 6000.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.00 825.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 74.50 4134.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 4.50 337.50 75.00
Subtotal (Total Children Is Unduplicated) 191 446.00 25739.75 57.71
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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 36 128.00 6400.00 50.00
INTR-INTR-INTERPRETER 4 4.75 237.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 2 8.00 543.04 67.88
PHY-97110-PT SESSION BY LICENSED PT 4 21.50 1429.42 66.48
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 79.75 5158.43 64.68
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 261 29166.0 14583.00 0.50
Subtotal (Total Children Is Unduplicated) 269 29588.0 37351.39 1.26
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Total 36509.00 246250.39 6.74
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Number of Children (Unduplicated) With at Least One Service 1808
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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 6892 24155.50 160929.01 161023.85
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 3572 11651.50 82706.36 82706.36
120 702.00 2615.02 0.00
Other 0 0.00 0.00 0.00
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Total 10584 36509.00 246250.39 243730.21