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
Payclass Filters:GR
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 410 205.50 7596.25 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 321 898.00 33115.00 36.88
TCON-TCON-TRANSITION CONFERENCE 83 83.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 657 1912.00 48906.75 25.58
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 4 5.00 250.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 14.00 1050.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.50 249.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.00 450.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 21 33.00 2210.75 66.99
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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 29.00 1450.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 24 26.00 1300.00 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 2 6.00 150.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 88.50 4425.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 3 12.00 814.56 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 1.50 101.82 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 93.03 6314.75 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 259 36271.0 18135.50 0.50
Subtotal (Total Children Is Unduplicated) 262 36546.5 34355.13 0.94
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Total 38491.53 85472.63 2.22
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Number of Children (Unduplicated) With at Least One Service 675
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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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 1 1.00 67.88 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
4008 38490.53 85404.75 0.00
Other 0 0.00 0.00 0.00
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Total 4009 38491.53 85472.63 0.00