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: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 411 205.75 7605.50 36.96
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 384 504.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 273 221.50 8195.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 709 2029.25 74962.00 36.94
TCON-TCON-TRANSITION CONFERENCE 83 83.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 726 3043.50 90763.00 29.82
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 4 5.00 250.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.00 150.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 8.00 600.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 8.50 471.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 15 19.00 816.50 42.97
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 106 167.00 12325.00 73.80
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 14.50 1087.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 34 52.50 3937.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 109 181.00 10045.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 34.50 2587.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 22 22.00 1067.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 15 15.00 727.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 13 13.00 650.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 53 53.00 2570.50 48.50
Subtotal (Total Children Is Unduplicated) 245 598.00 37436.25 62.60
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.00 826.00 413.00
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.00 76.92 38.46
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 62.25 3112.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 37 34.25 1712.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 7 2.75 68.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 6.50 325.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 8 3.75 93.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 7.25 362.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 10 4.25 106.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 16.25 812.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 11 4.75 118.75 25.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 5 12.00 84.00 7.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 22.00 550.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 57 292.25 14612.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 147 766.25 38262.50 49.93
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 36.00 1800.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 105 620.03 42090.51 67.88
OCCT-97530HM-OT SESSION BY OT ASST 7 101.75 5894.95 57.94
PHY-97110-PT SESSION BY LICENSED PT 127 790.01 53628.64 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 17.00 850.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 364 2240.90 152102.36 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 6 46.75 617.10 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 547 137513 68756.50 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 9 31.00 1550.00 50.00
Subtotal (Total Children Is Unduplicated) 583 142635 388414.48 2.72
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Total 146276.44 516613.73 3.53
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Number of Children (Unduplicated) With at Least One Service 753
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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 86 76.00 4487.17 0.00
P 3127 38441.79 115832.44 115823.19
D 1 2.00 100.00 0.00
S 2 1.25 77.13 0.00
H 38 97.25 5922.14 0.00
T 0 0.00 0.00 0.00
6872 107658.15 390194.85 0.00
Other 0 0.00 0.00 0.00
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Total 10126 146276.44 516613.73 115823.19