CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2008 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 878 1037.50 38369.00 36.98
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 856 1544.25 57091.00 36.97
TCM-T1017TL-TARGETED CASE MANAGEMENT 1351 12097.0 447289.75 36.98
Subtotal (Total Children Is Unduplicated) 1358 14678.8 542749.75 36.98
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 2.00 100.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 55.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 6.00 450.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 20 20.50 1537.50 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 3.50 186.00 53.14
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 60 65.50 4912.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 11.00 825.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 127 127.50 9562.50 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 10 10.00 405.00 40.50
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 7 7.00 527.65 75.38
SPCH-92506-SPEECH EVAL BY LICENSED SLP 12 15.00 727.50 48.50
Subtotal (Total Children Is Unduplicated) 165 274.00 19646.42 71.70
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 4.50 150.00 33.33
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 45 312.50 15625.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 404.50 25868.28 63.95
SPL-92508-GROUP SPL SESSION PER CHILD 11 35.00 462.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 51 6327.00 3230.00 0.51
Subtotal (Total Children Is Unduplicated) 93 7083.50 45335.28 6.40
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Total 22036.25 607731.45 27.58
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Number of Children (Unduplicated) With at Least One Service 1358
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Center 51
Flag Claims Units Chgs Paid
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R 3 3.00 187.00 0.00
U 0 0.00 0.00 0.00
B 11372 7591.00 289032.36 0.00
P 3 389.50 354.50 354.50
D 125 77.50 3131.62 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
13008 13975.25 315025.97 0.00
Other 0 0.00 0.00 0.00
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Total 24511 22036.25 607731.45 354.50