CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.75 27.75 37.00
Subtotal (Total Children Is Unduplicated) 1 0.75 27.75 37.00
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.00 122.00 40.67
EXIT-EXIT-TRANSITION ASSESSMENT 34 62.00 3100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.50 337.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 68 98.50 7072.50 71.80
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 9.50 712.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 86.00 6450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 146.00 8095.00 55.45
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 24.00 1784.10 74.34
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 6 6.00 270.67 45.11
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 144.73 48.24
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.00 437.14 54.64
Subtotal (Total Children Is Unduplicated) 214 459.00 29045.14 63.28
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 35.00 11497.80 328.51
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 24 27.50 1355.00 49.27
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 11 3.25 81.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 2.00 100.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 6 4.00 100.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.00 50.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.25 6.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 23.75 1187.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 5 9.00 270.00 30.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 32 259.00 6410.00 24.75
EIIF-90812-INDIVIDUAL PSYCHOTHERAPY, 45-50 MINUTES 1 5.00 271.55 54.31
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 9 75.00 3750.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 66.25 3312.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 242 1424.00 69223.00 48.61
INTR-INTR-INTERPRETER 28 484.00 4838.00 10.00
OCCT-97530-OT SESSION BY LICENSED OT 64 311.25 22099.91 71.00
OCCT-97530HM-OT SESSION BY OT ASST 2 10.00 543.20 54.32
PHY-97110-PT SESSION BY LICENSED PT 113 557.75 37971.15 68.08
PHY-97110HM-PT SESSION BY PT ASST 5 24.00 1303.68 54.32
RSPT-RSPT-RESPITE 1 65.00 520.00 8.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 546 3064.17 205986.16 67.22
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.00 162.96 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 30 96.25 1323.64 13.75
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 855 193615 106939.64 0.55
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 6 43.00 2150.00 50.00
Subtotal (Total Children Is Unduplicated) 1004 200209 481478.19 2.40
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Total 200669.17 510551.08 2.54
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Number of Children (Unduplicated) With at Least One Service 1064
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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 5024 127610.12 249635.87 249635.87
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 1.00 67.88 0.00
T 3248 67701.00 144060.58 144060.58
952 5240.05 109262.55 0.00
Other 129 117.00 7524.20 0.00
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Total 9354 200669.17 510551.08 393696.45