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
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 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 360 988.50 36038.00 36.46
TCON-TCON-TRANSITION CONFERENCE 61 62.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 623 1997.50 53335.50 26.70
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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 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 18 25.66 1924.32 74.99
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.00 300.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 35.65 1978.25 55.49
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 40 81.81 5157.57 63.04
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 15.00 750.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 16 11.25 562.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 3.25 162.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 81.30 4064.85 50.00
OCCT-97530-OT SESSION BY LICENSED OT 3 23.25 1578.21 67.88
PHY-97110-PT SESSION BY LICENSED PT 2 11.75 797.59 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 39.05 2633.50 67.44
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 218 27037.0 13518.50 0.50
Subtotal (Total Children Is Unduplicated) 219 27221.9 24067.65 0.88
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Total 29301.16 82560.72 2.82
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Number of Children (Unduplicated) With at Least One Service 631
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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 1 0.25 9.25 0.00
P 1 0.25 9.25 9.25
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 0 0.00 0.00 0.00
4160 29300.66 82542.22 0.00
Other 0 0.00 0.00 0.00
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Total 4162 29301.16 82560.72 9.25