CMS/EIP Fiscal Report Center: 09
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 58 41.75 1535.50 36.78
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5 5.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 96 74.75 2765.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 211 455.75 16862.75 37.00
Subtotal (Total Children Is Unduplicated) 213 577.25 21164.00 36.66
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 17.50 1312.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 8.00 600.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 18.50 1026.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 110 145.00 10875.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 63 109.00 8175.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 50 56.00 4200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 83 138.00 7659.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 18.00 1350.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 12 12.00 600.00 50.00
Subtotal (Total Children Is Unduplicated) 183 530.00 36359.25 68.60
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 22 1045.00 522.50 0.50
Subtotal (Total Children Is Unduplicated) 22 1045.00 522.50 0.50
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Total 2152.25 58045.75 26.97
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Number of Children (Unduplicated) With at Least One Service 226
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Center 09
Flag Claims Units Chgs Paid
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R 2 1.50 55.50 0.00
U 0 0.00 0.00 0.00
B 29 38.75 2275.75 0.00
P 840 1951.25 47759.25 47759.25
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
113 160.75 7955.25 0.00
Other 0 0.00 0.00 0.00
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Total 984 2152.25 58045.75 47759.25