CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2008 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 78 60.00 2220.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 66 107.75 3986.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 125 381.25 14097.00 36.98
Subtotal (Total Children Is Unduplicated) 135 549.00 20303.75 36.98
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.00 825.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 9.50 712.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 46.50 2569.75 55.26
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 104.50 7837.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 14 14.00 700.00 50.00
Subtotal (Total Children Is Unduplicated) 60 187.50 12794.75 68.24
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 1.25 62.50 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 25 1143.00 570.50 0.50
Subtotal (Total Children Is Unduplicated) 28 1144.25 633.00 0.55
----------------------------------------------------------------------------------------------------------------
Total 1880.75 33731.50 17.94
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 135
----------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 135 135.50 5949.25 0.00
P 525 1316.25 20534.75 20534.75
D 7 8.00 524.00 0.00
S 9 10.50 536.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
160 410.50 6187.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 836 1880.75 33731.50 20534.75