CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EIP DEI DEIP
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 408 225.50 8343.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 350 442.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 268 203.25 7520.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 688 1831.00 67044.00 36.62
TCON-TCON-TRANSITION CONFERENCE 56 57.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 703 2758.75 82907.75 30.05
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 8 9.00 450.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.50 337.50 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 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.00 333.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 69.00 5175.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 16.50 1237.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 69 109.00 6049.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 21.00 1575.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 3 3.00 150.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 111 256.50 16403.50 63.95
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 14.00 700.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 15 10.25 512.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.25 6.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 4.00 200.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 73 314.75 15737.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 12 90.50 6143.14 67.88
PHY-97110-PT SESSION BY LICENSED PT 2 9.75 661.83 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 140.75 9554.11 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 184 22092.0 11046.00 0.50
Subtotal (Total Children Is Unduplicated) 184 22676.8 44573.83 1.97
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Total 25692.00 143885.08 5.60
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Number of Children (Unduplicated) With at Least One Service 709
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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 1674 1001.50 42795.17 0.00
P 121 63.50 2349.50 2349.50
D 0 0.00 0.00 0.00
S 1 0.25 9.25 0.00
H 60 96.75 6218.33 0.00
T 0 0.00 0.00 0.00
4313 24530.00 92512.83 0.00
Other 0 0.00 0.00 0.00
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Total 6169 25692.00 143885.08 2349.50