CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Payclass Filters:GR
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 109 448.75 16372.50 36.48
Subtotal (Total Children Is Unduplicated) 185 641.75 23356.25 36.39
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Screening, Eval, and Assessment,Class #02
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
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 50 51.00 2548.50 49.97
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 17.70 1295.50 73.19
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 6.00 344.00 57.33
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 16.00 888.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 6.50 487.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 11 12.00 600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 82 121.70 6773.50 55.66
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 10.00 678.80 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 2.75 186.67 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 117 4943.00 2471.50 0.50
Subtotal (Total Children Is Unduplicated) 117 4955.75 3336.97 0.67
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Total 5719.20 33466.72 5.85
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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 0 0.00 0.00 0.00
P 8 73.25 243.75 243.75
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 71 560.75 3198.97 3198.97
1218 5085.20 30024.00 0.00
Other 0 0.00 0.00 0.00
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Total 1297 5719.20 33466.72 3442.72