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
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 5 7.00 525.00 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 4 5.00 375.00 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 57 100.00 7500.00 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 23 37.00 2775.00 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
SCREEN-T1023-INTERDISCIPLINARY SCREENING 15 15.00 750.00 50.00
Subtotal (Total Children Is Unduplicated) 132 352.00 24075.00 68.39
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 86 125.00 6250.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 16 29.50 1475.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 37.50 1875.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 34.00 1700.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 43 46.00 2300.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 11.00 275.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 59 253.25 12662.50 50.00
INTR-INTR-INTERPRETER 17 13.75 687.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 31 152.50 10351.70 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 2.00 108.64 54.32
PHY-97110-PT SESSION BY LICENSED PT 7 18.00 1221.84 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 110.00 7466.80 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 257 35873.0 17936.50 0.50
Subtotal (Total Children Is Unduplicated) 271 36705.5 64310.48 1.75
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Total 42212.25 252452.73 5.98
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Number of Children (Unduplicated) With at Least One Service 1459
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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 9264 40956.50 244685.05 244635.05
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
304 1255.75 7767.68 0.00
Other 0 0.00 0.00 0.00
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Total 9568 42212.25 252452.73 244635.05