CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Payclass Filters:GR
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 269 220.50 8158.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 366 496.25 18361.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 345 1638.50 60569.00 36.97
Subtotal (Total Children Is Unduplicated) 519 2356.25 87088.75 36.96
----------------------------------------------------------------------------------------------------------------
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 12 17.50 1312.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 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 15 20.00 1108.75 55.44
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 192 261.50 19537.50 74.71
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 20.00 1500.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 44.00 3255.00 73.98
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 182 253.00 14015.00 55.40
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 51 74.00 5550.00 75.00
Subtotal (Total Children Is Unduplicated) 288 697.75 46841.25 67.13
----------------------------------------------------------------------------------------------------------------
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 1 7.00 350.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 27.75 1839.05 66.27
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.00 54.32 54.32
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 117 9220.20 4666.60 0.51
Subtotal (Total Children Is Unduplicated) 119 9257.20 6972.47 0.75
----------------------------------------------------------------------------------------------------------------
Total 12311.20 140902.47 11.45
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 526
----------------------------------------------------------------------------------------------------------------
Center 01
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 513 8555.45 35714.90 35714.90
D 175 203.50 11654.00 0.00
S 58 79.00 2980.00 0.00
H 4 4.00 280.50 0.00
T 83 1184.50 6227.90 5262.90
3272 2268.00 82808.50 75.00
Other 15 16.75 1236.67 0.00
-------------------------------------------------
Total 4120 12311.20 140902.47 41052.80