CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 2163 2166.75 80169.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 15 15.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1814 2176.75 80530.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 3543 20062.8 742021.00 36.99
Subtotal (Total Children Is Unduplicated) 3554 24421.3 902721.25 36.96
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 15 29.00 1450.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 13 19.00 950.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 38.00 2850.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 65 124.50 9337.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 57 78.50 4356.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 194 266.00 19800.00 74.44
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 8.50 487.50 57.35
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 299 397.00 21966.00 55.33
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 293 461.50 34487.50 74.73
Subtotal (Total Children Is Unduplicated) 572 1422.00 95685.25 67.29
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 31 31.00 1255.50 40.50
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 20 34.50 1715.00 49.71
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 13.50 675.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 30 38.50 1925.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 41 686.00 34300.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 7 66.50 3734.00 56.15
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 5.00 250.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 36 510.00 17353.76 34.03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 62 31776.0 15879.50 0.50
Subtotal (Total Children Is Unduplicated) 108 33162.0 77112.76 2.33
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Total 59005.25 1075519.26 18.23
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Number of Children (Unduplicated) With at Least One Service 3555
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Center 01
Flag Claims Units Chgs Paid
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R 23 15.75 582.75 0.00
U 0 0.00 0.00 0.00
B 2960 1957.00 82356.25 9.25
P 4765 2820.50 106726.00 107194.00
D 1462 1240.50 56357.00 0.00
S 1546 1303.25 48539.75 0.00
H 89 117.75 7362.00 0.00
T 1321 32627.25 80396.26 45956.01
25643 14399.75 517567.25 0.00
Other 7018 4523.50 175632.00 0.00
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Total 44827 59005.25 1075519.26 153159.26