CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:TPIN
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2.00 262.50 131.25
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4 2.75 101.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 37 57.00 2053.50 36.03
Subtotal (Total Children Is Unduplicated) 39 61.75 2417.75 39.15
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.50 262.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 5.50 750.00 136.36
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.00 1312.50 119.32
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 11.50 1500.00 130.43
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 263.40 263.40
Subtotal (Total Children Is Unduplicated) 24 33.50 4143.90 123.70
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 78.50 9287.40 118.31
OCCT-97530-OT SESSION BY LICENSED OT 4 8.25 1876.62 227.47
Subtotal (Total Children Is Unduplicated) 22 86.75 11164.02 128.69
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Total 182.00 17725.67 97.39
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Number of Children (Unduplicated) With at Least One Service 77
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Center 54
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 15 15.25 4044.10 2348.19
D 0 0.00 0.00 0.00
S 1 1.00 235.80 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
179 165.75 13445.77 0.00
Other 0 0.00 0.00 0.00
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Total 195 182.00 17725.67 2348.19