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
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 308 204.75 7575.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 603 617.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 214 192.75 7131.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 648 2466.25 91251.25 37.00
TCON-TCON-TRANSITION CONFERENCE 177 182.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1082 3662.75 105958.75 28.93
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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 6 6.50 487.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 7.50 416.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 141 164.50 12337.50 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 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 140 216.00 11988.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 10.50 787.50 75.00
Subtotal (Total Children Is Unduplicated) 241 496.00 30766.75 62.03
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 9.00 610.92 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 14 1226.00 709.00 0.58
Subtotal (Total Children Is Unduplicated) 15 1235.00 1319.92 1.07
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Total 5393.75 138045.42 25.59
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Number of Children (Unduplicated) With at Least One Service 1114
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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 2 2.00 74.00 0.00
P 0 0.00 0.00 0.00
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
4251 4163.00 137160.67 0.00
Other 0 0.00 0.00 0.00
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Total 4281 5393.75 138045.42 696.20