CMS/EIP Fiscal Report Center: 10
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 34 17.25 638.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 709 789.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 713 860.75 31847.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 960 3660.25 135429.25 37.00
TCON-TCON-TRANSITION CONFERENCE 169 169.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1488 5496.25 167915.25 30.55
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.50 562.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.50 360.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 74.50 5587.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 45.50 3412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 21.00 1575.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 36 65.00 3607.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 26.50 1987.50 75.00
Subtotal (Total Children Is Unduplicated) 64 251.50 17468.25 69.46
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 6.50 325.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 7.75 387.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 28 244.00 12200.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 1.00 67.88 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 48 14265.0 7132.50 0.50
Subtotal (Total Children Is Unduplicated) 48 14524.3 20112.88 1.38
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Total 20272.00 205496.38 10.14
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Number of Children (Unduplicated) With at Least One Service 1496
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Center 10
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 19 9.75 360.75 0.00
P 0 0.00 0.00 0.00
D 18 17.25 892.25 892.25
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
7954 20245.00 204243.38 0.00
Other 0 0.00 0.00 0.00
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Total 7991 20272.00 205496.38 892.25