CMS/EIP Fiscal Report Center: 04
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 1626 1822.75 67441.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1269 1349.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 207 134.25 4931.25 36.73
TCM-T1017TL-TARGETED CASE MANAGEMENT 2222 20503.0 758592.50 37.00
Subtotal (Total Children Is Unduplicated) 2237 23809.0 830965.50 34.90
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 143 145.00 7250.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 146 139.50 6975.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 45 36.50 2737.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 19 17.00 1275.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 14.00 1050.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 144 198.00 14850.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 151 170.50 9462.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 244 189.00 14175.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 15.50 1162.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 164 133.50 10012.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 683 709.50 39377.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 551 639.00 47925.00 75.00
MED-99201-OUTPATIENT VISIT, NEW, 10 MINS 1 1.00 25.96 25.96
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 450 452.00 83475.50 184.68
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 16 16.00 4400.00 275.00
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 137 163.00 17115.00 105.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 11 11.00 1760.00 160.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 1273 3053.00 263174.46 86.20
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 6.00 440.52 73.42
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 204 149.25 7462.50 50.00
TRAN-TRAN-FAMILY TRANSPORTATION 1043 1192.00 8221.50 6.90
Subtotal (Total Children Is Unduplicated) 1074 1347.25 16124.52 11.97
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Total 28209.25 1110264.48 39.36
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Number of Children (Unduplicated) With at Least One Service 2240
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Center 04
Flag Claims Units Chgs Paid
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R 29 31.50 1165.50 0.00
U 0 0.00 0.00 0.00
B 2805 2706.50 105386.75 0.00
P 11404 10361.75 418916.46 410890.01
D 832 850.25 47231.00 22098.25
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
18954 14259.25 537564.77 0.00
Other 0 0.00 0.00 0.00
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Total 34024 28209.25 1110264.48 432988.26