CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Eligibility Filter:Not Part C
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 53 28.75 1063.75 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 94 100.00 3700.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 183 762.00 28194.00 37.00
Subtotal (Total Children Is Unduplicated) 183 890.75 32957.75 37.00
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 5.00 250.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.50 187.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.50 194.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 54 71.50 5362.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.50 187.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 18.00 1350.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 59 76.50 4245.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 48.50 3637.50 75.00
Subtotal (Total Children Is Unduplicated) 102 231.00 15640.00 67.71
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 5.00 250.00 50.00
INTR-INTR-INTERPRETER 1 1.50 75.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 39 1616.00 861.60 0.53
Subtotal (Total Children Is Unduplicated) 40 1622.50 1186.60 0.73
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Total 2744.25 49784.35 18.14
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Number of Children (Unduplicated) With at Least One Service 192
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Center 01
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 270 267.00 9879.00 0.00
P 135 1613.00 7756.35 7756.35
D 0 0.00 0.00 0.00
S 134 126.75 4689.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
681 666.00 22764.00 0.00
Other 59 71.50 4695.25 0.00
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Total 1279 2744.25 49784.35 7756.35