CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Payclass Filters:GR
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 102 242.00 8954.00 37.00
Subtotal (Total Children Is Unduplicated) 165 378.50 13560.50 35.83
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 81.50 6112.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 69.00 5175.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 23.00 1725.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 49.00 2719.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 8 8.00 400.00 50.00
Subtotal (Total Children Is Unduplicated) 71 239.50 16787.50 70.09
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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 1918.25 31010.50 16.17
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Number of Children (Unduplicated) With at Least One Service 170
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Center 09
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 219 691.25 15607.25 15607.25
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
285 258.25 9520.25 0.00
Other 0 0.00 0.00 0.00
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Total 580 1918.25 31010.50 21490.25