CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Eligibility Filter:DEI Only
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 81 54.00 1998.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 33 27.00 999.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 306 1122.75 41541.75 37.00
Subtotal (Total Children Is Unduplicated) 309 1204.75 44538.75 36.97
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 3.00 150.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 6.50 487.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 20 29.00 2175.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 16.50 915.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 13.00 975.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.50 787.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 28.50 1581.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 54 73.50 5512.50 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 84 181.50 12633.50 69.61
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 2.00 100.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 80.00 3983.25 49.79
PHY-97110-PT SESSION BY LICENSED PT 2 20.50 1391.43 67.87
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 12.50 848.50 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 21 6319.00 3170.20 0.50
Subtotal (Total Children Is Unduplicated) 25 6435.00 9543.38 1.48
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Total 7821.25 66715.63 8.53
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Number of Children (Unduplicated) With at Least One Service 309
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Center 01
Flag Claims Units Chgs Paid
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R 2 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 229 164.00 8656.50 0.00
P 472 5382.25 12976.68 12930.43
D 147 89.50 3577.50 0.00
S 611 429.75 12984.75 41.50
H 2 2.00 150.00 0.00
T 46 703.00 2330.05 2330.05
457 652.50 9728.65 73.00
Other 667 397.75 16293.00 0.00
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Total 2633 7821.25 66715.63 15374.98