CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Payclass Filters:GR
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 44 145.00 5365.00 37.00
TCON-TCON-TRANSITION CONFERENCE 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 84 275.75 8537.75 30.96
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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
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 15 37.50 2081.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.00 300.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.00 450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 28.00 1554.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 83.00 6225.00 75.00
Subtotal (Total Children Is Unduplicated) 35 164.50 10971.25 66.69
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.00 100.00 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 5663.00 2980.00 0.53
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Total 6103.25 22489.00 3.68
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Number of Children (Unduplicated) With at Least One Service 84
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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 0 0.00 0.00 0.00
P 56 1461.00 2458.00 2458.00
D 1 2.00 150.00 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
464 4640.25 19881.00 0.00
Other 0 0.00 0.00 0.00
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Total 521 6103.25 22489.00 2458.00