CMS/EIP Fiscal Report Center: 09
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 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 416 1135.75 42004.25 36.98
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 588 1626.25 58959.50 36.25
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 18.50 1387.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.00 525.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.50 337.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 8.00 444.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 106 174.50 13087.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 104 190.50 14287.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 57 90.00 6750.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 133 240.00 13320.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 63 94.00 7050.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 15.00 727.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 43 48.00 2400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 27 31.00 1503.50 48.50
Subtotal (Total Children Is Unduplicated) 310 927.00 62217.00 67.12
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EI Services,Class #03
INTR-INTR-INTERPRETER 4 2.25 112.50 50.00
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) 94 5259.25 5726.00 1.09
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Total 7812.50 126902.50 16.24
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Number of Children (Unduplicated) With at Least One Service 633
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Center 09
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 2472 7780.50 126756.50 126756.50
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
5 32.00 146.00 0.00
Other 0 0.00 0.00 0.00
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Total 2477 7812.50 126902.50 126756.50