CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 1712 2683.00 99262.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1193 1581.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1630 2452.00 90603.75 36.95
TCM-T1017TL-TARGETED CASE MANAGEMENT 2824 20060.5 741213.00 36.95
TCON-TCON-TRANSITION CONFERENCE 415 420.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2884 27196.5 931078.75 34.24
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 50 96.25 4812.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 4 8.00 444.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 234 342.00 25650.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 30 46.00 3450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 94 113.50 8512.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 205 305.50 22912.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 86 126.50 7020.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 34 61.00 3385.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 765 981.00 73575.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 297 537.50 40312.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 480 616.00 46200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 700 1112.00 61716.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 409 555.50 41662.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 7 7.00 339.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 11.00 533.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 14 16.00 776.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 17 20.00 970.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 82 87.00 4350.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 67 83.00 4025.50 48.50
Subtotal (Total Children Is Unduplicated) 1687 5124.75 350648.25 68.42
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 183 317.25 15862.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 53 133.00 6650.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.03 0.63 21.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 59 128.50 6425.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 2 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 37 112.75 5637.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 91 183.50 9175.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 15.00 375.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 197 2179.25 108864.50 49.96
INTR-INTR-INTERPRETER 40 109.75 5487.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 136 1896.75 128710.71 67.86
OCCT-97530HM-OT SESSION BY OT ASST 7 9.00 488.88 54.32
PHY-97110-PT SESSION BY LICENSED PT 57 750.75 50880.15 67.77
PHY-97110HM-PT SESSION BY PT ASST 6 10.00 543.20 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 105 911.25 61855.65 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 3 3.00 39.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 438 119267 59626.00 0.50
Subtotal (Total Children Is Unduplicated) 475 126028 460646.82 3.66
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Total 158349.03 1742373.82 11.00
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Number of Children (Unduplicated) With at Least One Service 2945
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Center 09
Flag Claims Units Chgs Paid
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R 154 144.75 7514.23 0.00
U 0 0.00 0.00 0.00
B 1865 1819.00 96663.67 572.25
P 45239 151733.78 1427996.07 1559096.72
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 4 6.25 231.25 231.25
T 0 0.00 0.00 0.00
3182 4645.25 209968.60 18.50
Other 0 0.00 0.00 0.00
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Total 50444 158349.03 1742373.82 1559918.72