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
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 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 1042 3682.75 136261.75 37.00
TCON-TCON-TRANSITION CONFERENCE 166 166.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1521 5556.25 169691.25 30.54
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.50 562.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.00 600.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.00 499.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 83.00 6225.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 45.50 3412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 28 41.50 3112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 63.00 3496.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 15.00 1125.00 75.00
Subtotal (Total Children Is Unduplicated) 72 274.00 19146.00 69.88
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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 14 100.00 5000.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 24 5734.00 2867.00 0.50
Subtotal (Total Children Is Unduplicated) 24 5840.25 8179.50 1.40
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Total 11670.50 197016.75 16.88
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Number of Children (Unduplicated) With at Least One Service 1523
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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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 94 52.50 1942.50 1942.50
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
7976 11618.00 195074.25 0.00
Other 0 0.00 0.00 0.00
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Total 8070 11670.50 197016.75 1942.50