CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 2217 3435.75 127104.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1316 1791.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1755 3205.00 118585.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1364 7510.00 277777.50 36.99
TCON-TCON-TRANSITION CONFERENCE 178 181.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2572 16122.8 523466.75 32.47
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 5 9.00 450.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.50 562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.50 416.25 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 184 359.50 19944.00 55.48
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 292 644.00 48300.00 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 5 6.00 436.68 72.78
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 3 1.00 50.00 50.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 3 3.00 150.00 50.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 72 72.00 3600.00 50.00
Subtotal (Total Children Is Unduplicated) 363 1109.50 73909.43 66.62
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 57 23.25 1162.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 3.00 150.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 234 14265.0 7097.50 0.50
Subtotal (Total Children Is Unduplicated) 280 14291.3 8410.00 0.59
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Total 31523.50 605786.18 19.22
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Number of Children (Unduplicated) With at Least One Service 2573
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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 1 0.50 18.50 0.00
P 22386 25604.75 478938.59 481121.59
D 116 69.50 2664.28 0.00
S 8 3.50 129.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5717 5845.25 124035.31 0.00
Other 0 0.00 0.00 0.00
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Total 28228 31523.50 605786.18 481121.59