CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
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 77 203.25 7520.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 49 54.00 0.00 0.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 14 30.00 1110.00 37.00
TCON-TCON-TRANSITION CONFERENCE 7 7.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 97 294.25 8630.25 29.33
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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 23 23.00 1150.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 9 9.00 450.00 50.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 5.00 277.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.00 450.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 74 86.00 4171.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 34 36.00 1746.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 46 57.00 2764.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 59 63.00 3015.00 47.86
SPCH-92506-SPEECH EVAL BY LICENSED SLP 232 255.00 12367.50 48.50
Subtotal (Total Children Is Unduplicated) 351 545.00 26597.00 48.80
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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 24 33.75 1687.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 432 1214.50 55100.00 45.37
CONIP-CONIP-CONSULT, ITDS, PHONE 551 2127.75 51106.25 24.02
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 448 1329.50 60937.50 45.83
CONSP-CONSP-CONSULT, SLP, PHONE 504 2019.50 49262.50 24.39
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 22 144.00 5285.52 36.71
ECE-ECE-EARLY CHILDHOOD EDUCATION 174 52032.0 468288.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 190.25 4065.00 21.37
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 13.00 650.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1108 20376.5 993640.00 48.76
OCCT-97530-OT SESSION BY LICENSED OT 160 1422.00 96416.80 67.80
OCCT-97530HM-OT SESSION BY OT ASST 68 2004.50 108884.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 192 1770.50 119645.92 67.58
PHY-97110HM-PT SESSION BY PT ASST 65 1710.50 92860.06 54.29
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 1 1.00 50.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 12 28.00 1400.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 389 3141.00 209870.88 66.82
SPL-92508-GROUP SPL SESSION PER CHILD 102 2530.00 33560.04 13.26
TRAN-TRAN-FAMILY TRANSPORTATION 57 5048.00 458686.00 90.86
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1205 515044 255147.60 0.50
Subtotal (Total Children Is Unduplicated) 1450 612256 3072919.26 5.02
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Total 613095.00 3108146.51 5.07
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Number of Children (Unduplicated) With at Least One Service 1460
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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 4 16.75 619.75 0.00
P 16 11.50 425.50 425.50
D 0 0.00 0.00 0.00
S 603 11649.25 46586.81 46186.37
H 0 0.00 0.00 0.00
T 18698 522826.25 1246302.04 1249281.26
6307 77558.00 1803215.36 442434.60
Other 134 1033.25 10997.05 11022.05
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Total 25762 613095.00 3108146.51 1749349.78