CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
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 796 740.75 27407.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 572 586.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 701 719.75 26566.00 36.91
TCM-T1017TL-TARGETED CASE MANAGEMENT 886 2976.25 110093.50 36.99
TCON-TCON-TRANSITION CONFERENCE 131 132.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1422 5154.75 164067.25 31.83
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 12.00 900.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 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 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 66 113.50 8512.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 50 79.00 5925.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 40.00 3000.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 56 96.00 5328.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 3.00 225.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 15 15.00 750.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.00 242.50 48.50
Subtotal (Total Children Is Unduplicated) 143 383.50 26252.00 68.45
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 89 132.25 6612.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 19 32.50 1625.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 25 39.50 1975.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 35.00 1750.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 48 56.00 2800.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 11.00 275.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 231 1612.25 76452.50 47.42
INTR-INTR-INTERPRETER 19 31.75 1587.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 202 1177.75 78143.73 66.35
OCCT-97530HM-OT SESSION BY OT ASST 7 20.00 1086.40 54.32
PHY-97110-PT SESSION BY LICENSED PT 137 794.00 52536.15 66.17
PHY-97110HM-PT SESSION BY PT ASST 4 20.00 1086.40 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 420 2731.50 183724.37 67.26
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 709 148649 74014.50 0.50
Subtotal (Total Children Is Unduplicated) 936 155343 483669.05 3.11
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Total 160880.75 673988.30 4.19
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Number of Children (Unduplicated) With at Least One Service 1603
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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 12604 156333.25 627611.85 627561.85
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
605 4547.50 46376.45 1643.63
Other 0 0.00 0.00 0.00
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Total 13209 160880.75 673988.30 629205.48