CMS/EIP Fiscal Report Center: 57
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
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 315 250.00 9250.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 465 688.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 229 175.50 6493.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1037 3458.00 127794.00 36.96
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1079 4574.50 143537.50 31.38
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 5 5.00 250.00 50.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 4 4.00 200.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 7 7.00 210.00 30.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 5.00 375.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 8.00 444.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 132 132.00 9820.50 74.40
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 40 40.00 3000.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 192 192.00 10656.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 21.00 1550.00 73.81
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 30 30.00 1455.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 16 16.00 776.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 16 16.00 776.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 19 19.00 921.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 6 6.00 300.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 76 77.00 3734.50 48.50
Subtotal (Total Children Is Unduplicated) 315 579.00 34543.50 59.66
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 14 15.00 750.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 206 329.00 16400.00 49.85
CONIP-CONIP-CONSULT, ITDS, PHONE 278 546.75 13656.25 24.98
CONOF-CONOF-CONSULT, OT, FACE TO FACE 7 11.25 562.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 3 3.50 87.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 2.50 125.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 5 7.00 175.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 211 346.00 17237.50 49.82
CONSP-CONSP-CONSULT, SLP, PHONE 266 530.75 13118.75 24.72
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 7 30.00 1050.00 35.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 102 9228.00 83052.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 73.00 1535.00 21.03
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 5.00 250.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 630 5299.50 258227.50 48.73
OCCT-97530-OT SESSION BY LICENSED OT 118 396.25 26829.57 67.71
OCCT-97530HM-OT SESSION BY OT ASST 1 8.00 434.56 54.32
PHY-97110-PT SESSION BY LICENSED PT 124 489.25 32999.87 67.45
PHY-97110HM-PT SESSION BY PT ASST 2 5.50 244.50 44.45
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 9.00 450.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 203 755.00 50468.88 66.85
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.00 26.40 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 28 1200.00 120000.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 671 131238 67308.80 0.51
Subtotal (Total Children Is Unduplicated) 823 150530 704989.58 4.68
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Total 155683.75 883070.58 5.67
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Number of Children (Unduplicated) With at Least One Service 1256
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Center 57
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 1033 956.50 35403.50 18.50
P 409 449.00 13875.50 13857.00
D 0 0.00 0.00 0.00
S 128 2395.00 8594.54 8594.54
H 0 0.00 0.00 0.00
T 5125 134226.75 330854.94 332015.13
5274 17287.00 493004.36 126715.09
Other 12 369.50 1337.74 1337.74
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Total 11981 155683.75 883070.58 482538.00