CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Eligibility Filter:Not Part C
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 28 11.00 407.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 28.25 1045.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 77 224.00 8195.50 36.59
Subtotal (Total Children Is Unduplicated) 78 264.25 9647.75 36.51
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.50 75.00 50.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 10 11.00 548.50 49.86
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 40.50 2438.00 60.20
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 16.50 1052.00 63.76
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 41.50 2303.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.50 337.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 7 7.00 350.00 50.00
Subtotal (Total Children Is Unduplicated) 51 122.50 7104.25 57.99
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 0.75 50.91 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 35 1063.00 531.50 0.50
Subtotal (Total Children Is Unduplicated) 35 1063.75 582.41 0.55
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Total 1450.50 17334.41 11.95
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Number of Children (Unduplicated) With at Least One Service 78
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Center 52
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 147 126.50 5659.00 0.00
P 19 8.25 305.25 305.25
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 19 27.50 1743.75 0.00
T 11 77.25 432.41 432.41
331 1211.00 9194.00 0.00
Other 0 0.00 0.00 0.00
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Total 527 1450.50 17334.41 737.66