CMS/EIP Fiscal Report Center: 52
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Eligibility Filter:Not Part C
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 37 16.50 610.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 68 56.25 2081.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 97 326.25 12062.00 36.97
Subtotal (Total Children Is Unduplicated) 98 399.00 14753.75 36.98
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 8 8.50 400.00 47.06
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 55.00 4125.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 31.00 2324.75 74.99
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 52 71.50 3968.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 7.50 562.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 10 10.00 475.00 47.50
Subtotal (Total Children Is Unduplicated) 72 188.50 12201.25 64.73
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 58 2859.00 1429.50 0.50
Subtotal (Total Children Is Unduplicated) 58 2859.00 1429.50 0.50
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Total 3446.50 28384.50 8.24
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Number of Children (Unduplicated) With at Least One Service 98
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Center 52
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 6 1.50 55.50 0.00
P 354 470.42 13459.75 13376.50
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 3 4.50 318.00 0.00
T 0 0.00 0.00 0.00
473 2970.08 14551.25 0.00
Other 0 0.00 0.00 0.00
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Total 836 3446.50 28384.50 13376.50