CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Eligibility Filter:Program Patients
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 320 214.75 7945.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 681 696.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 245 221.00 8177.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1486 5749.25 212722.25 37.00
TCON-TCON-TRANSITION CONFERENCE 180 186.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1507 7067.00 228845.00 32.38
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 6.00 300.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 79 79.00 3950.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 15.50 1162.50 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 13 20.00 1110.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 347 399.00 29925.00 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 6.00 450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 357 546.50 30330.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 15.00 1125.00 75.00
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) 599 1297.00 78776.75 60.74
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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 9107.00 81963.00 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 6636.50 331825.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 131 650.50 44155.94 67.88
PHY-97110-PT SESSION BY LICENSED PT 148 643.75 43697.75 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 459 2247.75 152577.27 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 6 5.50 72.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 837 176963 92045.10 0.52
Subtotal (Total Children Is Unduplicated) 1108 197146 781511.66 3.96
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Total 205510.00 1089133.41 5.30
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Number of Children (Unduplicated) With at Least One Service 1694
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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 2809 2971.00 115544.65 0.00
P 186 263.97 14620.71 14620.72
D 6 2.75 101.75 0.00
S 149 4704.00 7558.66 7636.24
H 0 0.00 0.00 0.00
T 4609 174225.03 378599.19 378645.01
7299 22375.50 569351.75 245925.28
Other 59 967.75 3356.70 3356.70
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Total 15117 205510.00 1089133.41 650183.95