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
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 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 2 1.75 64.75 37.00
TCON-TCON-TRANSITION CONFERENCE 7 7.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 89 266.00 7585.00 28.52
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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
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-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 3.00 166.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
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
SPCH-92506-SPEECH EVAL BY LICENSED SLP 164 174.00 8439.00 48.50
Subtotal (Total Children Is Unduplicated) 243 357.00 17351.50 48.60
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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 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 447 1324.00 60662.50 45.82
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 688 12194.5 585140.00 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 237 1778.75 118492.61 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 1168 511340 250907.60 0.49
Subtotal (Total Children Is Unduplicated) 1316 533854 1256519.59 2.35
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Total 534477.00 1281456.09 2.40
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Number of Children (Unduplicated) With at Least One Service 1370
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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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
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 18626 522546.25 1235147.88 1238127.10
41 388.00 2944.24 1342.99
Other 6 113.00 219.88 219.88
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Total 19249 534477.00 1281456.09 1282242.24