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:EIP DEI DEIP
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 308 204.75 7575.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 605 620.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 214 192.75 7131.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1376 5225.00 193325.00 37.00
TCON-TCON-TRANSITION CONFERENCE 177 183.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1399 6425.50 208032.50 32.38
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 4 4.00 200.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 79 79.00 3950.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 14.00 1050.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 18.50 1026.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 289 332.50 24937.50 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 6.00 450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 298 455.50 25280.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 13.50 1012.50 75.00
Subtotal (Total Children Is Unduplicated) 399 932.00 58582.00 62.86
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EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 76.00 684.00 9.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.00 200.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 4.00 271.52 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 2.00 135.76 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 15.50 1052.14 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 15 1264.00 728.00 0.58
Subtotal (Total Children Is Unduplicated) 17 1365.50 3071.42 2.25
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Total 8723.00 269685.92 30.92
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Number of Children (Unduplicated) With at Least One Service 1426
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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 2635 2721.50 104969.90 0.00
P 157 225.75 12450.25 12450.25
D 6 2.75 101.75 0.00
S 9 700.00 371.00 346.20
H 0 0.00 0.00 0.00
T 13 526.00 338.00 350.00
4493 4547.00 151455.02 200.00
Other 0 0.00 0.00 0.00
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Total 7313 8723.00 269685.92 13346.45