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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 482 1855.00 68616.50 36.99
Subtotal (Total Children Is Unduplicated) 482 1855.00 68616.50 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.50 187.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.00 300.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.00 150.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 9.00 675.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 13 18.50 1361.00 73.57
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 50.00 2500.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 13.00 827.76 63.67
Subtotal (Total Children Is Unduplicated) 16 63.00 3327.76 52.82
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Total 1936.50 73305.26 37.85
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Number of Children (Unduplicated) With at Least One Service 483
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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 2949 1928.00 72824.76 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 2.00 150.00 0.00
T 1 0.50 18.50 0.00
4 6.00 312.00 0.00
Other 0 0.00 0.00 0.00
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Total 2955 1936.50 73305.26 0.00