CMS/EIP Fiscal Report Center: 53
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 25 10.25 379.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 42 43.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 69 75.50 2793.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 85 295.50 10831.75 36.66
TCON-TCON-TRANSITION CONFERENCE 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 87 426.25 14004.50 32.86
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 2.00 100.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 16 39.50 2192.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.00 1166.14 83.30
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 20.00 1848.42 92.42
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 9.50 712.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 79.50 5187.95 65.26
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 145.00 11339.56 78.20
Subtotal (Total Children Is Unduplicated) 52 313.50 22807.82 72.75
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.00 200.00 50.00
INTR-INTR-INTERPRETER 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 51 5660.00 2830.00 0.50
Subtotal (Total Children Is Unduplicated) 51 5665.00 3080.00 0.54
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Total 6404.75 39892.32 6.23
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Number of Children (Unduplicated) With at Least One Service 87
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Center 53
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 87 98.25 4100.50 0.00
P 123 1567.50 8616.25 8503.75
D 2 4.00 300.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
534 4735.00 26875.57 0.00
Other 0 0.00 0.00 0.00
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Total 746 6404.75 39892.32 8503.75