CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
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 305 200.00 7400.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 486 619.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 279 353.75 11628.75 32.87
TCM-T1017TL-TARGETED CASE MANAGEMENT 1164 4236.00 156695.00 36.99
TCON-TCON-TRANSITION CONFERENCE 65 65.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1196 5473.75 175723.75 32.10
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 8 8.00 400.00 50.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 45 45.00 2250.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 3 4.00 120.00 30.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 6.00 430.50 71.75
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 15.00 832.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 182 183.00 13725.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 233 233.00 12931.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 53.00 3975.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 21 21.00 1018.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.00 291.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 14 14.00 679.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 14.00 638.50 45.61
SCREEN-T1023-INTERDISCIPLINARY SCREENING 3 4.00 200.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 83 83.00 4025.50 48.50
Subtotal (Total Children Is Unduplicated) 397 693.00 41792.00 60.31
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 9.25 462.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 311 601.50 29912.50 49.73
CONIP-CONIP-CONSULT, ITDS, PHONE 258 524.25 13093.75 24.98
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 16.00 800.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 5.75 287.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 6 8.25 206.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 298 577.00 28850.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 255 520.50 13012.50 25.00
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 59.00 2080.00 35.25
ECE-ECE-EARLY CHILDHOOD EDUCATION 114 18840.0 169560.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 40.00 720.00 18.00
EIIF-90801-PSYCHIATRIC DIAG INTERVIEW 1 8.00 400.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 639 5506.75 274962.50 49.93
OCCT-97530-OT SESSION BY LICENSED OT 122 581.50 39472.22 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 129 623.00 41997.94 67.41
PHY-97110HM-PT SESSION BY PT ASST 2 3.00 162.92 54.31
SHIN-EIIF_NM-INITIAL SHINE SERVICES, IND NONMED 1 1.00 50.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 2.00 100.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 246 1065.50 71918.86 67.50
SPL-92508-GROUP SPL SESSION PER CHILD 6 17.50 231.00 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 34 1277.00 106162.50 83.13
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 707 143444 74547.30 0.52
Subtotal (Total Children Is Unduplicated) 886 173733 869077.97 5.00
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Total 179899.25 1086593.72 6.04
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Number of Children (Unduplicated) With at Least One Service 1371
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Center 57
Flag Claims Units Chgs Paid
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R 126 141.00 5217.00 0.00
U 0 0.00 0.00 0.00
B 1066 1045.25 38655.75 0.00
P 627 587.50 21737.50 21737.40
D 10 10.75 397.75 0.00
S 238 5447.75 14666.39 14620.14
H 0 0.00 0.00 0.00
T 5573 142692.25 363800.96 365043.96
6264 29821.75 639226.45 135135.77
Other 38 153.00 2891.92 2873.42
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Total 13942 179899.25 1086593.72 539410.69