CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
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 309 203.25 7520.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 3 3.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 277 411.00 15207.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 483 1517.50 56027.25 36.92
Subtotal (Total Children Is Unduplicated) 496 2134.75 78754.50 36.89
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 16 16.00 900.00 56.25
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.50 637.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.50 305.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 52.00 3900.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 23.00 1725.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 4.50 337.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 124 228.50 12668.00 55.44
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 115 251.50 18862.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.00 339.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 5.00 242.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 70 70.00 3500.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 12 12.00 582.00 48.50
Subtotal (Total Children Is Unduplicated) 247 685.50 44149.75 64.41
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 3.50 175.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 100 5709.00 2853.50 0.50
Subtotal (Total Children Is Unduplicated) 107 5712.50 3028.50 0.53
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Total 8532.75 125932.75 14.76
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Number of Children (Unduplicated) With at Least One Service 498
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Center 07
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 393 347.75 14038.25 0.00
P 2536 7318.00 92254.50 92254.50
D 7 8.00 524.00 0.00
S 25 23.00 1073.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
453 836.00 18043.00 0.00
Other 0 0.00 0.00 0.00
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Total 3414 8532.75 125932.75 92254.50