CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Eligibility Filter:Not Part C
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 271 221.00 8177.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 369 500.25 18509.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 540 2898.25 107179.75 36.98
Subtotal (Total Children Is Unduplicated) 541 3620.50 133866.00 36.97
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 0.75 37.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 31.50 2325.00 73.81
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 28.50 1580.50 55.46
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 244 336.00 24925.04 74.18
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 22.50 1687.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 45 71.50 5317.50 74.37
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 272 375.50 20805.50 55.41
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 107 153.00 11475.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 4.00 173.50 43.38
Subtotal (Total Children Is Unduplicated) 412 1032.25 69002.04 66.85
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.25 62.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 18.50 925.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 12.00 765.00 63.75
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 31.25 2203.86 70.52
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.00 54.32 54.32
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 117 9416.20 4715.60 0.50
Subtotal (Total Children Is Unduplicated) 119 9480.20 8726.28 0.92
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Total 14132.95 211594.32 14.97
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Number of Children (Unduplicated) With at Least One Service 541
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Center 01
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 323 292.50 12620.75 0.00
P 966 8902.70 50049.91 50020.97
D 295 321.25 16321.50 0.00
S 170 204.00 7605.00 0.00
H 21 25.75 1710.25 0.00
T 110 1220.00 8588.15 7623.15
3386 2622.25 92222.84 124.00
Other 604 544.50 22475.92 0.00
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Total 5875 14132.95 211594.32 57768.12