CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:GR
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 2498.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1081 1195.75 42727.25 35.73
TCM-T1017TL-TARGETED CASE MANAGEMENT 1330 10403.3 384901.75 37.00
TCON-TCON-TRANSITION CONFERENCE 256 270.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2219 15186.8 457959.75 30.16
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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
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 13 14.00 1023.50 73.11
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 6.50 487.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 7.50 562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 24.50 1354.25 55.28
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 377 401.00 29617.20 73.86
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 156 175.00 12769.50 72.97
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 648 713.50 39516.50 55.38
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 165 189.00 13975.00 73.94
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
SCREEN-T1023-INTERDISCIPLINARY SCREENING 19 20.00 1000.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 165 175.00 8487.50 48.50
Subtotal (Total Children Is Unduplicated) 927 2013.00 122478.95 60.84
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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 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 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 449 1329.50 60925.00 45.83
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 690 12198.0 585315.00 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 238 1791.00 119324.14 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 1185 514029 252252.10 0.49
Subtotal (Total Children Is Unduplicated) 1330 536572 1259508.12 2.35
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Total 553771.50 1839946.82 3.32
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Number of Children (Unduplicated) With at Least One Service 2301
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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 576 11429.75 43144.09 42552.27
H 0 0.00 0.00 0.00
T 18712 523016.50 1236669.63 1241461.85
16849 19209.50 559848.47 3673.53
Other 6 113.00 219.88 219.88
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Total 36147 553771.50 1839946.82 1287990.78