CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:TPIN
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 2 0.50 18.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4 4.00 148.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 12 40.25 1489.25 37.00
Subtotal (Total Children Is Unduplicated) 15 44.75 1655.75 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.00 166.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 22.50 1487.54 66.11
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 21.00 1165.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 33.00 2475.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 3.00 125.00 41.67
Subtotal (Total Children Is Unduplicated) 38 84.00 5532.04 65.86
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 12.00 765.00 63.75
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.50 229.05 152.70
Subtotal (Total Children Is Unduplicated) 2 13.50 994.05 73.63
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Total 142.25 8181.84 57.52
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Number of Children (Unduplicated) With at Least One Service 53
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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 0 0.00 0.00 0.00
P 8 8.75 646.75 609.56
D 6 11.00 717.75 0.00
S 4 8.50 314.50 0.00
H 15 18.75 1234.00 0.00
T 17 23.00 1559.25 1559.25
38 58.25 2776.59 0.00
Other 10 14.00 933.00 0.00
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Total 98 142.25 8181.84 2168.81