CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2008 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 369 200.50 7409.25 36.95
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 387 479.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 302 267.50 9888.25 36.97
TCM-T1017TL-TARGETED CASE MANAGEMENT 655 1965.25 72011.25 36.64
TCON-TCON-TRANSITION CONFERENCE 61 62.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 669 2974.25 89308.75 30.03
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 5 5.50 275.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.50 337.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.50 249.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 94 136.00 10252.50 75.39
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.50 337.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 16.50 1237.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 118 177.50 9836.60 55.42
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 25.50 2020.00 79.22
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.00 194.00 48.50
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 3 3.00 150.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 9.00 388.00 43.11
Subtotal (Total Children Is Unduplicated) 170 397.50 25697.35 64.65
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 1100.00 550.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 15.00 750.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 16 11.50 575.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 3.25 162.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 69 271.00 13557.50 50.03
OCCT-97530-OT SESSION BY LICENSED OT 13 105.50 7405.38 70.19
PHY-97110-PT SESSION BY LICENSED PT 5 20.50 1710.74 83.45
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 51 219.00 15168.94 69.26
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 219 27629.0 13814.50 0.50
Subtotal (Total Children Is Unduplicated) 222 28276.8 54244.56 1.92
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Total 31648.50 169250.66 5.35
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Number of Children (Unduplicated) With at Least One Service 672
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Center 52
Flag Claims Units Chgs Paid
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R 8 8.00 534.34 0.00
U 0 0.00 0.00 0.00
B 1258 784.75 32890.92 9.25
P 778 512.34 24184.56 24184.56
D 0 0.00 0.00 0.00
S 3 9.50 351.50 0.00
H 88 163.25 10173.02 0.00
T 0 0.00 0.00 0.00
4379 30170.66 101116.32 0.00
Other 0 0.00 0.00 0.00
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Total 6514 31648.50 169250.66 24193.81