CMS/EIP Fiscal Report Center: 10
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 12 7.25 268.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 727 804.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 727 896.25 33161.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2002 7573.75 280228.75 37.00
TCON-TCON-TRANSITION CONFERENCE 166 166.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2012 9447.25 313658.25 33.20
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 28 48.50 3637.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 19.00 1425.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 17 27.00 2025.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.00 1050.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 28.50 1581.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 225 408.50 30637.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 140 242.00 18150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 129 198.00 14850.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 108 185.50 10295.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 114 158.00 11850.00 75.00
Subtotal (Total Children Is Unduplicated) 342 1329.00 95502.00 71.86
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 4.50 225.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.75 87.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 155.00 7750.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 1.00 67.88 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 24 5734.00 2867.00 0.50
Subtotal (Total Children Is Unduplicated) 24 5896.25 10997.38 1.87
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Total 16672.50 420157.63 25.20
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Number of Children (Unduplicated) With at Least One Service 2012
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Center 10
Flag Claims Units Chgs Paid
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R 5 1.75 64.75 0.00
U 0 0.00 0.00 0.00
B 6136 3793.75 141057.75 0.00
P 485 711.25 49681.75 49722.50
D 110 61.75 2284.75 2284.75
S 156 95.00 3515.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8205 12009.00 223553.63 0.00
Other 0 0.00 0.00 0.00
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Total 15097 16672.50 420157.63 52007.25