CMS/EIP Fiscal Report Center: 07
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 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 271 807.00 29859.00 37.00
Subtotal (Total Children Is Unduplicated) 460 1424.25 52586.25 36.92
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 5.00 350.00 70.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.50 337.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.50 194.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 50.00 3750.00 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 3 3.50 262.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 77 140.00 7757.75 55.41
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 62 136.00 10200.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 27 27.00 1350.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 142 397.50 26169.50 65.84
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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 7534.25 81784.25 10.86
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Number of Children (Unduplicated) With at Least One Service 463
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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 0 0.00 0.00 0.00
P 1953 6797.00 69351.25 69351.25
D 6 7.50 505.50 0.00
S 2 0.75 27.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
380 729.00 11899.75 0.00
Other 0 0.00 0.00 0.00
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Total 2341 7534.25 81784.25 69351.25