CMS/EIP Fiscal Report Center: 54
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:TPIN
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.50 55.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 11 21.25 703.00 33.08
Subtotal (Total Children Is Unduplicated) 12 24.75 758.50 30.65
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.50 262.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.00 337.50 168.75
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 11.50 2025.00 176.09
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 6.00 450.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 13.66 1362.50 99.74
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 8.00 444.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 71 80.16 14234.39 177.57
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 1.30 63.50 48.85
Subtotal (Total Children Is Unduplicated) 93 126.12 19179.39 152.07
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 2.00 135.76 67.88
Subtotal (Total Children Is Unduplicated) 1 2.00 135.76 67.88
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Total 152.87 20073.65 131.31
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Number of Children (Unduplicated) With at Least One Service 101
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Center 54
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 22 27.00 5906.26 3095.97
D 1 1.00 262.50 144.38
S 1 1.50 262.50 2.65
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
117 123.37 13642.39 63.29
Other 0 0.00 0.00 0.00
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Total 141 152.87 20073.65 3306.29