CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
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 17 7.50 277.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 15 18.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 27 28.75 1063.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 28 37.75 1396.75 37.00
Subtotal (Total Children Is Unduplicated) 56 92.00 2738.00 29.76
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
Subtotal (Total Children Is Unduplicated) 2 7.00 341.42 48.77
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
TRAN-TRAN-FAMILY TRANSPORTATION 1 1.00 10.80 10.80
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 135.00 67.50 0.50
Subtotal (Total Children Is Unduplicated) 2 138.00 195.30 1.42
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Total 237.00 3274.72 13.82
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Number of Children (Unduplicated) With at Least One Service 57
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Center 06
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 2 90.00 45.00 45.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
140 147.00 3229.72 0.00
Other 0 0.00 0.00 0.00
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Total 142 237.00 3274.72 45.00