CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
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 796 742.25 27463.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 577 591.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 704 722.00 26649.25 36.91
TCM-T1017TL-TARGETED CASE MANAGEMENT 1539 5179.00 191566.75 36.99
TCON-TCON-TRANSITION CONFERENCE 131 132.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1601 7366.25 245679.25 33.35
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 67 96.00 7200.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 13.00 975.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 33 35.50 2662.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 37 63.50 4762.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 24.50 1359.75 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 277 348.00 26100.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 84 131.50 9862.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 162 196.00 14700.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 156 238.50 13236.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 46.00 3450.00 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 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 6.00 291.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.00 145.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 23 26.00 1300.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 12.00 582.00 48.50
Subtotal (Total Children Is Unduplicated) 435 1245.50 86932.50 69.80
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 90 133.75 6687.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 19 32.50 1625.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 26 41.50 2075.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 36.00 1800.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 48 56.00 2800.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 12.00 300.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 370 2518.25 121752.50 48.35
INTR-INTR-INTERPRETER 19 31.75 1587.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 357 2299.25 154305.09 67.11
OCCT-97530HM-OT SESSION BY OT ASST 14 42.75 2322.18 54.32
PHY-97110-PT SESSION BY LICENSED PT 308 2000.75 134432.46 67.19
PHY-97110HM-PT SESSION BY PT ASST 12 100.50 5459.16 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 619 4008.25 270390.16 67.46
SPL-92508-GROUP SPL SESSION PER CHILD 1 6.50 85.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 709 148789 74084.50 0.50
Subtotal (Total Children Is Unduplicated) 1084 160109 779706.85 4.87
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Total 168720.50 1112318.60 6.59
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Number of Children (Unduplicated) With at Least One Service 1764
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Center 09
Flag Claims Units Chgs Paid
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R 5 7.00 372.00 0.00
U 0 0.00 0.00 0.00
B 553 549.50 29366.59 27.75
P 15121 158514.00 723525.46 723486.13
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 0.75 27.75 27.75
T 0 0.00 0.00 0.00
3403 9649.25 359026.80 1643.63
Other 0 0.00 0.00 0.00
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Total 19083 168720.50 1112318.60 725185.26