CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Agency Filter:EXT
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 1 0.75 27.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 14 14.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 39 141.25 5226.25 37.00
TCON-TCON-TRANSITION CONFERENCE 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 47 158.00 5254.00 33.25
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Screening, Eval, and Assessment,Class #02
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 15.00 727.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 14 14.00 679.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 11.00 533.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 17 18.00 873.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 140 143.00 6935.50 48.50
Subtotal (Total Children Is Unduplicated) 174 201.00 9748.50 48.50
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 172 232.00 11600.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 38 44.50 1112.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.00 50.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 8.00 400.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 1.00 25.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 200 273.00 13650.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 36 42.50 1062.50 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 63 9031.00 81279.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 289.00 7225.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 763 6632.50 331625.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 131 646.50 43884.42 67.88
PHY-97110-PT SESSION BY LICENSED PT 148 641.75 43561.99 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 457 2232.25 151525.13 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 6 5.50 72.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 828 175659 91289.10 0.52
Subtotal (Total Children Is Unduplicated) 1098 195741 778412.24 3.98
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Total 196099.50 793414.74 4.05
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Number of Children (Unduplicated) With at Least One Service 1105
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Center 57
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 3 1.72 116.71 116.72
D 0 0.00 0.00 0.00
S 140 4004.00 7187.66 7290.04
H 0 0.00 0.00 0.00
T 4595 173659.03 378233.19 378267.01
2505 17467.00 404520.48 245725.28
Other 59 967.75 3356.70 3356.70
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Total 7302 196099.50 793414.74 634755.75