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: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 667 313.75 11608.75 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 582 594.75 22005.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2009 5710.75 211272.00 37.00
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2047 6620.25 244886.50 36.99
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.00 50.00 25.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 12.50 625.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 46 71.50 3575.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 16.00 1212.36 75.77
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.00 450.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 18.00 988.00 54.89
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 140 197.50 14700.00 74.43
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 14.00 889.00 63.50
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 42 76.00 5700.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 169 246.00 13653.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 100 134.00 10050.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 33.50 33.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 82.00 41.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 9 9.00 466.11 51.79
Subtotal (Total Children Is Unduplicated) 375 813.50 53020.97 65.18
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 30.00 9584.02 319.47
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 43 66.75 2942.30 44.08
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 7 2.00 50.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 6 5.75 287.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 1.00 25.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.00 50.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 6.00 300.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 32.50 1625.00 50.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 5 40.00 300.00 7.50
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 36 719.00 7975.00 11.09
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 34.00 1700.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 25 111.75 5587.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 285 1497.75 74887.50 50.00
INTR-INTR-INTERPRETER 42 284.25 8617.50 30.32
OCCT-97530-OT SESSION BY LICENSED OT 67 278.25 19026.84 68.38
OCCT-97530HM-OT SESSION BY OT ASST 6 14.00 767.26 54.80
PHY-97110-PT SESSION BY LICENSED PT 102 473.75 32281.41 68.14
PHY-97110HM-PT SESSION BY PT ASST 2 7.00 380.24 54.32
RSPT-RSPT-RESPITE 1 53.00 424.00 8.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 5.00 250.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 456 2425.25 158707.64 65.44
SPL-92508-GROUP SPL SESSION PER CHILD 20 149.25 944.51 6.33
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 943 190243 101062.96 0.53
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 7 79.00 3950.00 50.00
Subtotal (Total Children Is Unduplicated) 1075 196560 431732.43 2.20
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Total 203993.25 729639.90 3.58
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Number of Children (Unduplicated) With at Least One Service 2170
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Center 01
Flag Claims Units Chgs Paid
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R 8 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 2797 1990.75 74239.25 0.00
P 9472 188625.00 368955.77 368955.72
D 8 5.25 246.25 0.00
S 1135 873.50 32319.50 0.00
H 0 0.00 0.00 0.00
T 1 1.25 46.25 0.00
6852 12187.50 235050.99 0.00
Other 254 305.00 18596.89 0.00
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Total 20527 203993.25 729639.90 368955.72