CMS/EIP Fiscal Report Center: 55
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 133 63.00 2331.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 255 310.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 59 36.50 1350.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 289 844.75 31163.25 36.89
TCON-TCON-TRANSITION CONFERENCE 37 37.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 444 1291.25 34844.75 26.99
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 5 7.00 875.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 23 34.50 1725.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.00 225.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 13.50 1012.50 75.00
Subtotal (Total Children Is Unduplicated) 38 59.50 3950.00 66.39
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Total 1350.75 38794.75 28.72
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Number of Children (Unduplicated) With at Least One Service 446
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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 0 0.00 0.00 0.00
D 16 12.25 453.25 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
1507 1338.50 38341.50 0.00
Other 0 0.00 0.00 0.00
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Total 1523 1350.75 38794.75 0.00