CMS/EIP Fiscal Report Center: 51
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 429 329.75 12191.50 36.97
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 310 409.50 15151.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 355 1375.25 50884.25 37.00
Subtotal (Total Children Is Unduplicated) 661 2114.50 78227.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.50 75.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 8.00 600.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 4.00 194.00 48.50
Subtotal (Total Children Is Unduplicated) 9 14.50 944.00 65.10
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 27.00 1350.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 95.00 5898.34 62.09
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 18 1759.00 873.50 0.50
Subtotal (Total Children Is Unduplicated) 27 1881.00 8121.84 4.32
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Total 4010.00 87293.09 21.77
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Number of Children (Unduplicated) With at Least One Service 668
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Center 51
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 1 1.50 75.00 75.00
D 54 32.50 1202.50 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
3641 3976.00 86015.59 0.00
Other 0 0.00 0.00 0.00
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Total 3696 4010.00 87293.09 75.00