CMS/EIP Fiscal Report Center: 55
Services beginning 01/01/2008 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 461 302.75 11192.50 36.97
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 734 1344.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 483 489.50 18111.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1212 7486.00 276668.75 36.96
TCON-TCON-TRANSITION CONFERENCE 220 221.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1212 9843.25 305972.75 31.08
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 15 20.00 2500.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 182 272.50 13675.00 50.18
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.00 450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 13.50 1012.50 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 21 35.00 2625.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 30.00 2211.00 73.70
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 9.00 675.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 35.00 1942.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 181 271.50 20737.50 76.38
Subtotal (Total Children Is Unduplicated) 382 697.50 46164.50 66.19
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 0.75 50.91 67.88
Subtotal (Total Children Is Unduplicated) 1 0.75 50.91 67.88
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Total 10541.50 352188.16 33.41
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Number of Children (Unduplicated) With at Least One Service 1212
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Center 55
Flag Claims Units Chgs Paid
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R 38 47.00 1739.00 0.00
U 0 0.00 0.00 0.00
B 75 106.50 7227.00 0.00
P 3690 3685.75 139449.00 139313.28
D 144 148.50 6925.50 111.00
S 26 27.75 1083.75 0.00
H 10 15.00 1368.00 0.00
T 0 0.00 0.00 0.00
7077 6511.00 194395.91 0.00
Other 0 0.00 0.00 0.00
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Total 11060 10541.50 352188.16 139424.28