CMS/EIP Fiscal Report Center: 52
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Agency Filter:EIP DEI DEIP
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 5.00 375.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 8.50 471.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 77 127.00 9525.00 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 14 22.50 1687.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 104 172.00 9546.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 27.00 2025.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 13 13.00 650.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 159 395.50 25427.75 64.29
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.00 826.00 413.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 30 29.25 1462.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 24 26.25 1312.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 4.00 200.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 4.00 200.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 7.00 350.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.75 18.75 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 22.00 550.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 45.75 2287.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 79 368.25 18412.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 12 81.00 5498.28 67.88
PHY-97110-PT SESSION BY LICENSED PT 21 85.00 5769.80 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 318.25 21602.81 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 263 36385.0 18192.50 0.50
Subtotal (Total Children Is Unduplicated) 267 37379.3 76701.89 2.05
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Total 40818.25 192892.64 4.73
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Number of Children (Unduplicated) With at Least One Service 732
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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 2421 1553.22 68183.37 68174.12
D 0 0.00 0.00 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
4278 39090.53 114222.83 0.00
Other 0 0.00 0.00 0.00
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Total 6825 40818.25 192892.64 68174.12