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
Payclass Filters:GR
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 419 452.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 552 591.00 21811.50 36.91
TCM-T1017TL-TARGETED CASE MANAGEMENT 799 2515.75 92925.50 36.94
TCON-TCON-TRANSITION CONFERENCE 66 69.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1266 4316.25 140202.50 32.48
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 14 13.00 650.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 20.00 1500.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 12.00 900.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.00 525.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 8.00 444.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 67.50 5062.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 79.00 5925.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 32.00 2400.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 91.50 5078.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 9.00 675.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 8 8.00 400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 131 353.00 23930.25 67.79
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 57 69.25 3462.50 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 16 28.00 1400.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 2 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 25.75 1287.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 37 44.75 2237.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 58 306.25 15312.50 50.00
INTR-INTR-INTERPRETER 17 60.00 3000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 24 111.50 7568.62 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.00 54.32 54.32
PHY-97110-PT SESSION BY LICENSED PT 11 54.00 3665.52 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 54.32 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 111.50 7568.62 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.00 26.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 249 43463.0 21724.00 0.50
Subtotal (Total Children Is Unduplicated) 259 44310.0 68936.80 1.56
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Total 48979.25 233069.55 4.76
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Number of Children (Unduplicated) With at Least One Service 1298
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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 17 13.75 521.75 0.00
P 2888 16927.00 82655.56 82655.56
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 1434 28044.25 49784.35 49784.35
4496 3994.25 100107.89 50.00
Other 0 0.00 0.00 0.00
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Total 8835 48979.25 233069.55 132489.91