CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Eligibility Filter:Not Part C
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 102 47.25 1748.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 4.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 167 141.75 5235.50 36.93
TCM-T1017TL-TARGETED CASE MANAGEMENT 187 813.25 29748.00 36.58
Subtotal (Total Children Is Unduplicated) 187 1006.25 36731.75 36.50
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.50 75.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 50.00 50.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 48.50 48.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 50 56.00 2791.00 49.84
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 89 117.50 7837.00 66.70
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 41.00 2829.00 69.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 83 116.00 6508.50 56.11
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 19.50 1462.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 13.00 630.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 27 28.00 1400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 174 407.50 24290.50 59.61
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 10.50 712.74 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 2.75 186.67 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 119 5203.00 2601.50 0.50
Subtotal (Total Children Is Unduplicated) 119 5216.25 3500.91 0.67
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Total 6630.00 64523.16 9.73
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Number of Children (Unduplicated) With at Least One Service 188
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Center 52
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 334 244.50 10247.50 0.00
P 300 298.25 10240.25 10145.00
D 0 0.00 0.00 0.00
S 1 3.25 120.25 0.00
H 48 64.50 4166.50 0.00
T 71 560.75 3198.97 3198.97
1320 5458.75 36549.69 120.00
Other 0 0.00 0.00 0.00
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Total 2074 6630.00 64523.16 13463.97