CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EIP DEI DEIP
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
CASE-CASE-NON-TCM CASE MANAGEMENT 748 688.50 25465.50 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 420 453.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 552 591.75 21839.25 36.91
TCM-T1017TL-TARGETED CASE MANAGEMENT 1373 4474.50 165290.25 36.94
TCON-TCON-TRANSITION CONFERENCE 66 69.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1443 6276.75 212595.00 33.87
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 14 13.00 650.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 4.00 222.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 76 114.00 8550.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 15.00 1125.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 26 31.00 2325.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 43 72.00 5400.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 37.00 2053.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 5 10.00 555.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 214 279.00 20925.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 136.00 10200.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 128 165.00 12375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 191 288.00 15984.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 83.00 6225.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 14 14.00 700.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 445 1270.00 87726.00 69.08
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 57 70.75 3537.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 11 31.00 1550.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 30.00 1500.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 2 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 27.75 1387.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 41 50.75 2537.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 105 539.00 26950.00 50.00
INTR-INTR-INTERPRETER 17 60.00 3000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 67 474.75 32212.47 67.85
OCCT-97530HM-OT SESSION BY OT ASST 3 3.00 162.96 54.32
PHY-97110-PT SESSION BY LICENSED PT 37 215.50 14628.14 67.88
PHY-97110HM-PT SESSION BY PT ASST 4 4.00 217.28 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 48 247.50 16800.30 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 3 3.00 39.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 249 43463.0 21724.00 0.50
Subtotal (Total Children Is Unduplicated) 263 45221.0 126272.25 2.79
----------------------------------------------------------------------------------------------------------------
Total 52767.75 426593.25 8.08
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1548
----------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 15.75 948.55 0.00
U 0 0.00 0.00 0.00
B 544 541.50 30143.08 77.75
P 5314 19092.25 177400.94 204397.19
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.75 64.75 64.75
T 1434 28044.25 49784.35 49784.35
5439 5071.00 168205.33 50.00
Other 2 1.25 46.25 0.00
-------------------------------------------------
Total 12755 52767.75 426593.25 254374.04