CMS/EIP Fiscal Report Center: 09
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 165 171.50 6336.25 36.95
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 28 31.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 331 287.00 10619.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 736 2073.50 76701.00 36.99
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 742 2564.00 93656.25 36.53
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 55.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 47 54.50 4087.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 13.00 975.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 36 38.00 2850.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 30 35.00 2625.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 46.00 2553.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 17 26.00 1443.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 374 465.50 34912.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 173 316.50 23737.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 217 271.00 20325.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 351 572.00 31746.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 206 266.00 19875.00 74.72
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 15 18.00 873.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 56 61.00 3050.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 29 34.00 1649.00 48.50
Subtotal (Total Children Is Unduplicated) 740 2219.50 150854.00 67.97
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-INTR-INTERPRETER 4 2.25 112.50 50.00
PHY-97110-PT SESSION BY LICENSED PT 3 4.00 271.52 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 54.32 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 4.00 271.52 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 1 30.00 3000.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 92 5227.00 2613.50 0.50
Subtotal (Total Children Is Unduplicated) 98 5268.25 6323.36 1.20
----------------------------------------------------------------------------------------------------------------
Total 10051.75 250833.61 24.95
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 798
----------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 13.00 783.00 0.00
U 0 0.00 0.00 0.00
B 168 224.50 12994.51 75.00
P 3641 9240.75 201234.50 201243.70
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
476 573.50 35821.60 9.25
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4293 10051.75 250833.61 201327.95