CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Eligibility Filter:Not Part C
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 43 45.25 1674.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 9 12.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 97 79.25 2932.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 197 495.75 18342.75 37.00
Subtotal (Total Children Is Unduplicated) 201 632.25 22949.25 36.30
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Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 55.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 10.00 750.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.00 525.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 11.00 825.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 7.00 388.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 5 7.00 388.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 115 163.00 12225.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 53 110.00 8250.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 72 90.00 6750.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 100 159.00 8824.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 28.00 2100.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 11 11.00 550.00 50.00
Subtotal (Total Children Is Unduplicated) 201 606.00 41782.00 68.95
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 0.25 12.50 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 22 1300.00 650.00 0.50
Subtotal (Total Children Is Unduplicated) 23 1300.25 662.50 0.51
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Total 2538.50 65393.75 25.76
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Number of Children (Unduplicated) With at Least One Service 238
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Center 09
Flag Claims Units Chgs Paid
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R 1 1.00 50.00 0.00
U 0 0.00 0.00 0.00
B 26 32.50 1920.50 75.00
P 535 1101.00 36658.25 36658.25
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 76 968.75 5883.00 5883.00
432 435.25 20882.00 0.00
Other 0 0.00 0.00 0.00
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Total 1070 2538.50 65393.75 42616.25