CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
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 35 23.00 851.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 65 70.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 95 123.00 4551.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 52 131.25 4856.25 37.00
Subtotal (Total Children Is Unduplicated) 133 347.25 10258.25 29.54
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 225.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.50 337.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.00 150.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.00 225.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.00 300.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
Subtotal (Total Children Is Unduplicated) 11 22.50 1503.92 66.84
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 13.00 650.00 50.00
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
TRAN-TRAN-FAMILY TRANSPORTATION 2 2.00 54.80 27.40
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 5 747.00 373.50 0.50
Subtotal (Total Children Is Unduplicated) 6 764.00 1195.30 1.56
----------------------------------------------------------------------------------------------------------------
Total 1133.75 12957.47 11.43
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 136
----------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
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 52 322.00 998.50 998.50
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
533 811.75 11958.97 101.75
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 585 1133.75 12957.47 1100.25