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
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 1712 2681.50 99206.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1188 1575.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1627 2449.00 90492.75 36.95
TCM-T1017TL-TARGETED CASE MANAGEMENT 1744 11644.8 430078.75 36.93
TCON-TCON-TRANSITION CONFERENCE 415 420.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2624 18770.3 619778.00 33.02
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 44 73.75 3687.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 60 87.00 6525.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 21.00 1575.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 16 22.00 1650.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 52 74.00 5550.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 22 33.00 1831.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 4 5.00 277.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 178 291.50 21862.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 187 346.50 25987.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 101 160.50 12037.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 252 441.50 24503.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 107 161.50 12112.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.00 145.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 7.00 339.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 10 12.00 582.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 15 18.00 873.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 61 62.00 3100.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 61 77.00 3734.50 48.50
Subtotal (Total Children Is Unduplicated) 661 1898.25 126485.25 66.63
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 181 309.25 15462.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 53 132.00 6600.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.03 0.63 21.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 54 110.50 5525.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 2 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 101.75 5087.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 87 171.50 8575.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 11.00 275.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 126 1258.25 62912.50 50.00
INTR-INTR-INTERPRETER 40 109.75 5487.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 62 528.00 35840.64 67.88
OCCT-97530HM-OT SESSION BY OT ASST 3 4.00 217.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 17 199.00 13508.12 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 1.00 54.32 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 63 338.00 22943.44 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.00 26.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 438 119122 59553.50 0.50
Subtotal (Total Children Is Unduplicated) 467 122399 242094.33 1.98
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Total 143067.53 988357.58 6.91
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Number of Children (Unduplicated) With at Least One Service 2643
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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 34829 141792.28 979330.74 979157.74
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
325 1275.25 9026.84 0.00
Other 0 0.00 0.00 0.00
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Total 35154 143067.53 988357.58 979157.74