CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2008 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 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 58 86.00 6450.00 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 25 27.50 2062.50 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 249 314.50 23587.50 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 142 175.00 13125.00 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 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 23 26.00 1300.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 419 1150.00 80379.50 69.90
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 87 126.50 6325.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 16 29.50 1475.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 24 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 43 46.00 2300.00 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 111 494.25 24712.50 50.00
INTR-INTR-INTERPRETER 17 13.75 687.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 77 568.75 38606.75 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 32 152.25 10316.85 67.76
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 55 189.50 12863.26 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 257 35963.0 17981.50 0.50
Subtotal (Total Children Is Unduplicated) 273 37672.0 119402.00 3.17
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Total 46188.25 445460.75 9.64
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Number of Children (Unduplicated) With at Least One Service 1663
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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 11779 43133.75 340353.96 340203.96
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
1408 2497.25 75340.45 0.00
Other 0 0.00 0.00 0.00
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Total 13746 46188.25 445460.75 340259.46