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
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 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 9 9.00 436.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 8 8.00 388.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 10 11.00 533.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 79 80.00 3880.00 48.50
Subtotal (Total Children Is Unduplicated) 100 113.00 5480.50 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 162 211.75 10587.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 37 42.50 1062.50 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 197 265.50 13275.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 36 42.50 1062.50 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 354 2879.50 143975.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 56 215.32 14616.03 67.88
PHY-97110-PT SESSION BY LICENSED PT 46 139.25 9452.29 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 301 1414.21 95996.51 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 794 172364 89640.40 0.52
Subtotal (Total Children Is Unduplicated) 961 177586 380192.73 2.14
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Total 177856.53 390927.23 2.20
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Number of Children (Unduplicated) With at Least One Service 988
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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 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 138 4000.00 7117.08 7219.46
H 0 0.00 0.00 0.00
T 4591 173654.03 377956.37 377990.19
202 197.00 5543.02 289.02
Other 5 5.50 310.76 310.76
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Total 4936 177856.53 390927.23 385809.43