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
Payclass Filters:GR
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 2159 2162.75 80021.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 15 15.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1795 2135.50 79004.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2088 9945.25 367782.00 36.98
Subtotal (Total Children Is Unduplicated) 3251 14258.5 526808.00 36.95
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 10 19.00 950.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 13 19.00 950.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 29.50 2212.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 22 35.50 2662.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 16.00 888.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 135 180.50 13387.50 74.17
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.00 375.00 53.57
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 103 139.50 7685.75 55.09
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 85 134.50 9962.50 74.07
Subtotal (Total Children Is Unduplicated) 268 580.50 39073.75 67.31
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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 17 31.00 1540.00 49.68
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 8.00 400.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 30 37.00 1850.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 19 502.50 25125.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 7 34.00 1816.00 53.41
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 504.00 16993.76 33.72
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 62 31776.0 15879.50 0.50
Subtotal (Total Children Is Unduplicated) 87 32924.5 64884.76 1.97
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Total 47763.50 630766.51 13.21
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Number of Children (Unduplicated) With at Least One Service 3254
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Center 01
Flag Claims Units Chgs Paid
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R 2 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 2 1.75 64.75 0.00
P 29 28.00 1184.00 1174.12
D 644 638.50 33371.50 0.00
S 500 415.75 15402.25 0.00
H 26 31.50 2031.75 0.00
T 1173 32436.75 68204.01 33778.26
25392 14182.25 509013.25 0.00
Other 27 27.00 1421.00 0.00
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Total 27795 47763.50 630766.51 34952.38