CMS/EIP Fiscal Report Center: 54
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 269 110.50 4079.25 36.92
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 263 267.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 486 554.50 20507.25 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 563 1581.00 58090.00 36.74
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 914 2514.00 82676.50 32.89
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 6.50 360.75 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 18.00 999.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 11.50 862.50 75.00
Subtotal (Total Children Is Unduplicated) 25 38.00 2372.25 62.43
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 2.00 100.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 17 20.75 1037.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 16.00 800.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 32 193.25 9662.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 7.00 350.00 50.00
INTR-INTR-INTERPRETER 2 4.00 200.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 164 27533.0 23455.05 0.85
Subtotal (Total Children Is Unduplicated) 167 27776.8 35623.80 1.28
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Total 30328.75 120672.55 3.98
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Number of Children (Unduplicated) With at Least One Service 953
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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 0 0.00 0.00 0.00
D 16 9.75 360.75 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
4448 30319.00 120311.80 0.00
Other 0 0.00 0.00 0.00
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Total 4464 30328.75 120672.55 0.00