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
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 483 489.50 18111.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 622 3724.00 137583.75 36.95
TCON-TCON-TRANSITION CONFERENCE 220 221.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1036 6080.25 166887.75 27.45
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 14 18.00 2250.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 160 238.50 11925.00 50.00
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 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 29.00 2175.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 28.50 2098.50 73.63
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 5 9.50 527.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 61.50 4612.50 75.00
Subtotal (Total Children Is Unduplicated) 234 404.50 25050.75 61.93
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Total 6484.75 191938.50 29.60
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Number of Children (Unduplicated) With at Least One Service 1038
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Center 55
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 6 12.50 803.50 803.50
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
6929 6329.25 184559.50 0.00
Other 0 0.00 0.00 0.00
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Total 7075 6484.75 191938.50 914.50