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:Program Patients
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 1010 989.50 36611.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 969 1114.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1001 985.25 36454.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2206 7092.00 262276.50 36.98
TCON-TCON-TRANSITION CONFERENCE 294 414.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2272 10594.8 335342.25 31.65
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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 60 102.50 7687.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.00 525.00 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 36 64.50 4837.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 41.50 2303.25 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 504 716.00 53775.00 75.10
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 63 104.50 7837.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 114 172.00 12849.55 74.71
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 401 614.50 34049.25 55.41
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 119 162.50 12187.50 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) 814 2296.25 151835.05 66.12
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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 1029 291466 145733.00 0.50
Subtotal (Total Children Is Unduplicated) 1423 308244 1194176.82 3.87
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Total 321134.50 1681354.12 5.24
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Number of Children (Unduplicated) With at Least One Service 2396
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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 4562 4288.00 194144.86 0.00
P 10901 192352.25 589598.77 591278.02
D 0 0.00 0.00 0.00
S 2 3.00 195.75 0.00
H 1 1.00 50.00 50.00
T 5869 111019.50 330073.77 330073.77
4800 13465.75 567105.97 2265.36
Other 0 0.00 0.00 0.00
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Total 26139 321134.50 1681354.12 923667.15