CMS/EIP Fiscal Report Center: 57
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 800 800.00 29600.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1471 2303.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 959 1095.50 39018.00 35.62
TCM-T1017TL-TARGETED CASE MANAGEMENT 1211 9755.00 360916.50 37.00
TCON-TCON-TRANSITION CONFERENCE 256 270.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2019 14223.5 429534.50 30.20
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 3.00 75.00 25.00
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 22 22.00 1100.00 50.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 5.00 250.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 93 94.00 4700.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 15 16.00 480.00 30.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 14.00 1023.50 73.11
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.50 262.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 5.50 412.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 22 23.50 1298.75 55.27
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 331 352.50 25979.70 73.70
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 123 136.50 9935.00 72.78
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 561 617.00 34166.25 55.37
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 140 162.50 12012.50 73.92
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 49 59.00 2861.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 21 23.00 1115.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 22 29.00 1406.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 29 32.00 1532.00 47.88
SCREEN-T1023-INTERDISCIPLINARY SCREENING 11 12.00 600.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 164 174.00 8439.00 48.50
Subtotal (Total Children Is Unduplicated) 819 1785.00 107725.20 60.35
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 7.00 3612.75 516.11
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 27 39.75 1987.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 429 1211.00 54925.00 45.36
CONIP-CONIP-CONSULT, ITDS, PHONE 549 2118.00 50862.50 24.01
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 32.75 1637.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 5 9.25 231.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 9.25 462.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 7 17.25 431.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 449 1329.50 60925.00 45.83
CONSP-CONSP-CONSULT, SLP, PHONE 504 2010.50 49037.50 24.39
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 20 138.00 4868.42 35.28
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 28.00 252.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 189.25 4040.00 21.35
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 13.00 650.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 690 12198.0 585315.00 47.98
OCCT-97530-OT SESSION BY LICENSED OT 58 416.50 28262.02 67.86
PHY-97110-PT SESSION BY LICENSED PT 86 576.75 38971.27 67.57
PHY-97110HM-PT SESSION BY PT ASST 1 1.50 27.22 18.15
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 1 1.00 50.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 21.00 1050.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 238 1791.00 119324.14 66.62
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 6 382.00 245.00 0.64
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1175 513429 251952.10 0.49
Subtotal (Total Children Is Unduplicated) 1319 535970 1259133.12 2.35
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Total 551978.75 1796392.82 3.25
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Number of Children (Unduplicated) With at Least One Service 2101
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Center 57
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 1 1.25 46.25 0.00
P 3 1.50 18.50 83.25
D 0 0.00 0.00 0.00
S 576 11429.75 43144.09 42552.27
H 0 0.00 0.00 0.00
T 18703 522828.00 1236045.13 1240837.35
15809 17605.25 516918.97 3493.53
Other 6 113.00 219.88 219.88
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Total 35098 551978.75 1796392.82 1287186.28