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:EIP DEI DEIP
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 735 596.75 22079.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1456 2252.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 959 1095.50 39018.00 35.62
TCM-T1017TL-TARGETED CASE MANAGEMENT 2205 16875.3 624330.75 37.00
TCON-TCON-TRANSITION CONFERENCE 249 263.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2216 21082.5 685428.50 32.51
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 5.00 250.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 84 85.00 4250.00 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 25 26.50 1941.50 73.26
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 9.00 675.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 16.50 1237.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 51 56.00 3102.50 55.40
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 514 544.50 40315.70 74.04
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 206 231.50 17060.00 73.69
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 898 978.50 54152.25 55.34
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 240 275.00 20250.00 73.64
SCREEN-T1023-INTERDISCIPLINARY SCREENING 13 14.00 700.00 50.00
Subtotal (Total Children Is Unduplicated) 1082 2258.50 144489.45 63.98
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 6.00 300.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 5.50 262.50 47.73
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 3.50 175.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 6 25.00 1697.00 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 13.25 899.41 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 39 2089.00 1044.50 0.50
Subtotal (Total Children Is Unduplicated) 56 2143.25 4391.61 2.05
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Total 25484.25 834309.56 32.74
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Number of Children (Unduplicated) With at Least One Service 2218
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Center 57
Flag Claims Units Chgs Paid
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R 265 310.00 11755.00 0.00
U 0 0.00 0.00 0.00
B 3423 3428.50 126832.50 64.75
P 3387 3338.25 123516.25 123529.27
D 11 11.50 425.50 0.00
S 1 1.25 46.25 0.00
H 0 0.00 0.00 0.00
T 78 283.75 1047.25 2860.25
16588 18110.50 570668.31 2261.54
Other 1 0.50 18.50 0.00
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Total 23754 25484.25 834309.56 128715.81