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:Not Part C
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 85 42.25 1563.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 20 20.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 275 264.75 9795.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 322 1260.50 46629.25 36.99
Subtotal (Total Children Is Unduplicated) 430 1587.50 57988.25 36.53
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.00 52.98 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.00 64.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.00 130.74 21.79
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 23.00 1725.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 19.50 1462.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 13.00 975.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
Subtotal (Total Children Is Unduplicated) 35 75.50 4561.02 60.41
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-INTR-INTERPRETER 5 10.00 585.00 58.50
PHY-97110-PT SESSION BY LICENSED PT 2 4.50 305.46 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 0.50 18.94 37.88
TRAN-TRAN-FAMILY TRANSPORTATION 5 5.00 58.68 11.74
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7 473.00 236.50 0.50
Subtotal (Total Children Is Unduplicated) 8 493.00 1204.58 2.44
----------------------------------------------------------------------------------------------------------------
Total 2156.00 63753.85 29.57
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 440
----------------------------------------------------------------------------------------------------------------
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 140 571.75 4233.89 4233.89
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
2037 1584.25 59519.96 9.25
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2177 2156.00 63753.85 4243.14