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
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 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 650 4104.50 150035.00 36.55
TCON-TCON-TRANSITION CONFERENCE 270 273.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1134 8231.75 221787.25 26.94
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 3.00 150.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 27 29.00 1450.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 70 104.66 7849.32 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 18.50 1387.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 104 156.15 8666.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 30.00 2250.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.00 145.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 4.74 229.55 48.43
SCREEN-T1023-INTERDISCIPLINARY SCREENING 7 8.00 400.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 9 9.00 436.50 48.50
Subtotal (Total Children Is Unduplicated) 180 371.55 23337.87 62.81
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 77.00 38.50
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 39 41.00 2050.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 31 27.25 1362.50 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 10 11.50 575.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 43 377.12 18854.90 50.00
OCCT-97530-OT SESSION BY LICENSED OT 7 72.75 4938.27 67.88
PHY-97110-PT SESSION BY LICENSED PT 3 30.25 2053.37 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 266.82 18093.41 67.81
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 469 90273.5 45136.77 0.50
Subtotal (Total Children Is Unduplicated) 471 91104.5 93197.47 1.02
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Total 99707.78 338322.59 3.39
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Number of Children (Unduplicated) With at Least One Service 1138
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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 3 0.75 27.75 0.00
P 1 0.25 9.25 9.25
D 1 4.00 200.00 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
16814 99702.78 338085.59 107.45
Other 0 0.00 0.00 0.00
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Total 16819 99707.78 338322.59 116.70