CMS/EIP Fiscal Report Center: 55
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
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 461 302.75 11192.50 36.97
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 734 1343.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 483 490.00 18130.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 622 3725.50 137639.25 36.95
TCON-TCON-TRANSITION CONFERENCE 220 221.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1036 6082.25 166961.75 27.45
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 14 18.00 2250.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 165 250.50 12711.00 50.74
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.28 545.63 74.95
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 10.24 767.44 74.95
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.44 482.52 74.93
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 187 304.05 22804.33 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 89 145.84 10896.64 74.72
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 42 60.63 4547.72 75.01
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 103.50 5744.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 61.50 4612.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 23 22.92 1108.82 48.38
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 47 47.05 2281.83 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 14 12.93 627.06 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 29 29.72 1441.38 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 95 99.82 4840.90 48.50
Subtotal (Total Children Is Unduplicated) 502 1182.92 75823.02 64.10
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 17.00 9638.65 566.98
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 12.25 612.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.00 150.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 3 3.00 75.00 25.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.25 31.25 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 14 78.25 3912.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 23 333.50 16675.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 48 645.50 32275.00 50.00
INTR-INTR-INTERPRETER 3 16.00 724.00 45.25
OCCT-97530-OT SESSION BY LICENSED OT 150 1317.53 89419.29 67.87
OCCT-97530HM-OT SESSION BY OT ASST 13 53.78 2907.48 54.06
PHY-97110-PT SESSION BY LICENSED PT 96 1567.59 57069.34 36.41
PHY-97110HM-PT SESSION BY PT ASST 12 93.45 5072.31 54.28
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 301 5067.99 246294.13 48.60
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 458 243181 189424.24 0.78
Subtotal (Total Children Is Unduplicated) 574 252391 654280.69 2.59
----------------------------------------------------------------------------------------------------------------
Total 259656.26 897065.46 3.45
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1072
----------------------------------------------------------------------------------------------------------------
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
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 22427 253182.01 705856.46 705856.46
D 140 143.00 6575.50 111.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
6931 6331.25 184633.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 29498 259656.26 897065.46 705967.46