CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Eligibility Filter:Program Patients
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 572 243.25 9000.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 572 602.75 22292.50 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 2145 5428.75 200854.50 37.00
Subtotal (Total Children Is Unduplicated) 2167 6274.75 232147.25 37.00
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.00 122.00 40.67
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 5.00 250.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 36 64.50 3225.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 18.50 1387.50 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 2 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 5.50 412.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 21.50 1193.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 169 243.00 17910.00 73.70
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 15.00 1125.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 66 117.50 8812.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 209 304.00 16864.00 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 99 140.00 10484.10 74.89
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) 434 963.00 63196.39 65.62
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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 3 4.50 225.00 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 16 25.25 1262.50 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 14 68.25 3412.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 265 1515.00 73773.00 48.70
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 115 563.25 38344.49 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
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 5.00 250.00 50.00
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 887 195867 108205.84 0.55
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 6 43.00 2150.00 50.00
Subtotal (Total Children Is Unduplicated) 1046 202569 488217.73 2.41
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Total 209806.67 783561.37 3.73
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Number of Children (Unduplicated) With at Least One Service 2289
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Center 01
Flag Claims Units Chgs Paid
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R 1 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 911 636.25 23541.25 0.00
P 5096 128623.12 253495.52 253273.52
D 229 205.75 8748.50 0.00
S 614 491.00 18167.00 0.00
H 52 71.00 4568.13 0.00
T 3320 68860.75 148419.78 148373.53
6708 8941.80 241942.99 0.00
Other 2874 1976.75 84668.95 0.00
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Total 19805 209806.67 783561.37 401647.05