CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2008 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 48 26.50 980.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1997 3185.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2111 3481.50 128815.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2021 14960.3 553436.75 36.99
TCON-TCON-TRANSITION CONFERENCE 701 703.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 3230 22356.3 683232.75 30.56
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 38.50 2887.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 15.50 1162.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 16 27.00 2025.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.00 1050.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 56.50 3135.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 170 297.00 22275.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 130 212.50 15937.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 109 161.50 12112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 206 376.00 20868.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 72 105.00 7875.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 356 1306.50 89474.25 68.48
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 59 84.00 4200.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.50 25.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 52 79.00 3950.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 11.00 550.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 66 41.25 2062.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.25 6.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 129 1641.75 82087.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 6 19.25 1306.69 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 1.00 67.88 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 14.50 984.26 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 223 124753 62376.50 0.50
Subtotal (Total Children Is Unduplicated) 225 126646 157629.08 1.24
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Total 150308.75 930336.08 6.19
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Number of Children (Unduplicated) With at Least One Service 3245
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Center 10
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 20 10.00 370.00 0.00
P 4 3.50 55.50 203.50
D 438 316.75 13239.50 13230.25
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
33232 149976.00 916578.58 0.00
Other 2 2.50 92.50 92.50
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Total 33696 150308.75 930336.08 13526.25