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
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 735 596.75 22079.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1456 2249.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 959 1095.50 39018.00 35.62
TCM-T1017TL-TARGETED CASE MANAGEMENT 1211 9753.25 360851.75 37.00
TCON-TCON-TRANSITION CONFERENCE 249 263.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1999 13957.5 421949.50 30.23
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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 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 21 22.50 1243.25 55.26
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 558 614.00 33999.75 55.37
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 139 160.50 11862.50 73.91
SCREEN-T1023-INTERDISCIPLINARY SCREENING 11 12.00 600.00 50.00
Subtotal (Total Children Is Unduplicated) 694 1428.00 90373.70 63.29
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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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 12.25 831.53 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 39 2089.00 1044.50 0.50
Subtotal (Total Children Is Unduplicated) 48 2116.25 2613.53 1.24
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Total 17501.75 514936.73 29.42
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Number of Children (Unduplicated) With at Least One Service 2006
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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 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 77 281.75 897.25 2710.25
15768 17217.25 513974.73 2150.54
Other 0 0.00 0.00 0.00
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Total 15849 17501.75 514936.73 4944.04