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:OTHER
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.75 27.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 75 187.25 6928.25 37.00
Subtotal (Total Children Is Unduplicated) 75 189.00 6956.00 36.80
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.00 225.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.50 562.50 75.00
Subtotal (Total Children Is Unduplicated) 6 10.50 787.50 75.00
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 11.00 550.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 3 15.00 1018.20 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 11.00 746.68 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 10.00 678.80 67.88
Subtotal (Total Children Is Unduplicated) 6 47.00 2993.68 63.70
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Total 246.50 10737.18 43.56
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Number of Children (Unduplicated) With at Least One Service 86
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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 5 19.00 1128.80 1128.80
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
273 227.50 9608.38 0.00
Other 0 0.00 0.00 0.00
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Total 278 246.50 10737.18 1128.80