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:GR
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 987.00 36519.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 965 1110.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1000 983.75 36398.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1073 3397.25 125633.50 36.98
TCON-TCON-TRANSITION CONFERENCE 294 414.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1998 6892.00 198551.25 28.81
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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 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 74 120.50 9037.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 13.50 1012.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 26.50 1899.55 71.68
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 65 111.00 6160.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 4.50 337.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.00 242.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 8 8.00 388.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 246 574.75 33869.05 58.93
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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 242 1894.25 94712.50 50.00
INTR-INTR-INTERPRETER 4 4.75 237.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 166 1336.75 87651.81 65.57
OCCT-97530HM-OT SESSION BY OT ASST 6 21.75 897.16 41.25
PHY-97110-PT SESSION BY LICENSED PT 133 901.75 58784.17 65.19
PHY-97110HM-PT SESSION BY PT ASST 6 53.00 2268.76 42.81
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.00 130.00 130.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 526 4313.50 289724.13 67.17
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1029 291466 145733.00 0.50
Subtotal (Total Children Is Unduplicated) 1226 300405 700609.86 2.33
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Total 307871.25 933030.16 3.03
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Number of Children (Unduplicated) With at Least One Service 2156
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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 10742 192161.50 577125.67 577220.51
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 5869 111019.50 330073.77 330073.77
352 4690.25 25830.72 2071.63
Other 0 0.00 0.00 0.00
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Total 16963 307871.25 933030.16 909365.91