CMS/EIP Fiscal Report Center: 52
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 885 932.75 34484.00 36.97
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 886 1914.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 905 1007.50 37268.25 36.99
TCM-T1017TL-TARGETED CASE MANAGEMENT 1129 7522.00 275568.75 36.64
TCON-TCON-TRANSITION CONFERENCE 270 273.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1161 11649.3 347321.00 29.81
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 10 10.50 533.25 50.79
EXIT-EXIT-TRANSITION ASSESSMENT 27 29.00 1450.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.00 675.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.50 337.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 10.50 582.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 280 414.50 30906.40 74.56
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 9.50 712.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 69.00 5175.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 357 540.00 30116.10 55.77
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 74 100.00 7715.00 77.15
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.00 242.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 17 18.00 873.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 19 20.00 1000.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 31 34.00 1692.00 49.76
Subtotal (Total Children Is Unduplicated) 519 1278.50 82333.00 64.40
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.00 1177.00 294.25
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 39 41.00 2050.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 32 28.50 1425.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 0.75 18.75 25.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.25 6.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 12.50 625.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 108 1003.00 50165.00 50.01
OCCT-97530-OT SESSION BY LICENSED OT 20 286.00 19683.17 68.82
PHY-97110-PT SESSION BY LICENSED PT 7 53.00 3916.84 73.90
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 92 726.00 50648.55 69.76
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 471 91412.0 45706.00 0.50
Subtotal (Total Children Is Unduplicated) 475 93568.3 175452.81 1.88
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Total 106496.00 605106.81 5.68
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Number of Children (Unduplicated) With at Least One Service 1163
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Center 52
Flag Claims Units Chgs Paid
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R 9 8.25 543.59 0.00
U 0 0.00 0.00 0.00
B 4351 2645.25 111450.87 60.16
P 3131 1933.76 88083.81 88743.94
D 1 4.00 200.00 0.00
S 8 22.00 814.00 0.00
H 291 525.00 32051.64 0.00
T 0 0.00 0.00 0.00
17181 101357.74 371962.90 227.45
Other 0 0.00 0.00 0.00
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Total 24972 106496.00 605106.81 89031.55