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
Payclass Filters:GR
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
Subtotal (Total Children Is Unduplicated) 45 89.00 2553.00 28.69
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 4 4.00 200.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 19 19.00 921.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 11.00 533.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 9 9.00 436.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 10 10.00 485.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 59 59.00 2861.50 48.50
Subtotal (Total Children Is Unduplicated) 90 112.00 5438.00 48.55
----------------------------------------------------------------------------------------------------------------
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 205 328.50 16375.00 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 211 345.50 17212.50 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 1 28.00 252.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 72.00 1510.00 20.97
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 5.00 250.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 370 3165.00 151602.50 47.90
OCCT-97530-OT SESSION BY LICENSED OT 33 109.25 7405.89 67.79
PHY-97110-PT SESSION BY LICENSED PT 42 125.75 8505.91 67.64
PHY-97110HM-PT SESSION BY PT ASST 1 1.50 27.22 18.15
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 5 8.00 400.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 102 420.50 27968.84 66.51
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 666 130587 66983.30 0.51
Subtotal (Total Children Is Unduplicated) 747 136343 328024.76 2.41
----------------------------------------------------------------------------------------------------------------
Total 136544.25 336015.76 2.46
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 778
----------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
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 120 2368.00 7244.54 7244.54
H 0 0.00 0.00 0.00
T 5091 134052.75 327407.44 328160.63
10 48.50 1326.28 701.82
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5222 136544.25 336015.76 336144.49