CMS/EIP Fiscal Report Center: 57
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EXT
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 41 69.00 2553.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 20 20.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 1.50 55.50 37.00
Subtotal (Total Children Is Unduplicated) 46 90.50 2608.50 28.82
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 5 5.00 250.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
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
SPCH-92506-SPEECH EVAL BY LICENSED SLP 76 77.00 3734.50 48.50
Subtotal (Total Children Is Unduplicated) 126 165.00 8043.50 48.75
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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 628 5297.00 258102.50 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 669 131133 67256.30 0.51
Subtotal (Total Children Is Unduplicated) 822 150423 704812.08 4.69
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Total 150678.25 715464.08 4.75
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Number of Children (Unduplicated) With at Least One Service 827
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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 0 0.00 0.00 0.00
P 1 75.00 37.50 37.50
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 5113 134180.75 330837.44 331590.63
1447 13658.00 374656.86 126715.09
Other 12 369.50 1337.74 1337.74
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Total 6701 150678.25 715464.08 468275.50