CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Eligibility Filter:Program Patients
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 834 819.75 30330.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1646 2501.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1081 1195.75 42727.25 35.73
TCM-T1017TL-TARGETED CASE MANAGEMENT 2408 18026.3 666917.75 37.00
TCON-TCON-TRANSITION CONFERENCE 256 270.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2442 22812.8 739975.75 32.44
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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
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 18 19.00 570.00 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 10 12.00 900.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 17 21.50 1612.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 57 63.00 3491.00 55.41
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 598 631.00 46803.20 74.17
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 259 292.50 21555.50 73.69
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1058 1151.50 63748.25 55.36
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 282 323.00 23825.00 73.76
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
SCREEN-T1023-INTERDISCIPLINARY SCREENING 21 22.00 1100.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 233 256.00 12416.00 48.50
Subtotal (Total Children Is Unduplicated) 1436 3186.00 195909.45 61.49
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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 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 9 10.75 537.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 7 17.25 431.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 450 1335.00 61200.00 45.84
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 1110 20380.0 993815.00 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 197 1795.50 121342.92 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 391 3154.25 210770.29 66.82
SPL-92508-GROUP SPL SESSION PER CHILD 103 2531.00 33573.24 13.26
TRAN-TRAN-FAMILY TRANSPORTATION 57 5048.00 458686.00 90.86
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1222 517733 256492.10 0.50
Subtotal (Total Children Is Unduplicated) 1466 615001 3077685.87 5.00
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Total 640999.25 4013571.07 6.26
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Number of Children (Unduplicated) With at Least One Service 2468
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Center 57
Flag Claims Units Chgs Paid
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R 287 338.50 12885.50 0.00
U 0 0.00 0.00 0.00
B 3584 3674.00 135916.00 64.75
P 3555 3564.50 131952.25 131965.22
D 11 11.50 425.50 0.00
S 605 11650.75 46642.31 46186.37
H 0 0.00 0.00 0.00
T 18785 523298.50 1247973.79 1252766.01
24081 97427.75 2426760.17 445098.14
Other 135 1033.75 11015.55 11022.05
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Total 51043 640999.25 4013571.07 1887102.54