CMS/EIP Fiscal Report Center: 53
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 215 168.75 6243.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 362 440.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 414 658.75 24373.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 286 744.50 27509.50 36.95
TCON-TCON-TRANSITION CONFERENCE 113 114.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 611 2126.00 58127.00 27.34
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 68 128.75 6437.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 5.00 277.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.50 487.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.50 249.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 54 106.00 5883.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 24.00 1800.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.00 450.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.50 562.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 57.50 3191.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 94.00 7050.00 75.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 2 3.00 150.00 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 165 444.75 26636.00 59.89
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 144 200.75 10037.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 30 30.50 762.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.50 125.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.00 50.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 3.00 150.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 12.00 600.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 101.00 2525.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 3.00 75.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 40 157.00 7850.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 5.00 250.00 50.00
INTR-INTR-INTERPRETER 6 7.00 350.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 5 31.00 2077.16 67.01
OCCT-97530HM-OT SESSION BY OT ASST 2 4.00 217.28 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 4.00 200.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 406 45085.0 22503.50 0.50
Subtotal (Total Children Is Unduplicated) 433 45646.8 47772.94 1.05
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Total 48217.50 132535.94 2.75
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Number of Children (Unduplicated) With at Least One Service 662
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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 372 8928.75 17372.50 17372.50
D 3 5.00 185.00 185.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
3834 39283.75 114978.44 0.00
Other 0 0.00 0.00 0.00
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Total 4209 48217.50 132535.94 17557.50