CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:GR
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 580 592.25 21913.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1008 2677.50 99041.75 36.99
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1549 3584.50 132563.75 36.98
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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 3 6.50 325.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 46 71.50 3575.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 10.00 750.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 9.00 499.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 72 103.00 7634.51 74.12
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 12.50 779.31 62.34
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 25.00 1875.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 68 104.50 5799.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 56.00 4200.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 33.50 33.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 82.00 41.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 201 409.00 26000.57 63.57
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 21.00 5347.31 254.63
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 42 64.25 2817.30 43.85
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 9 6.50 325.00 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 30 632.00 5800.00 9.18
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 34.00 1700.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 41.00 2050.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 195 1076.75 53837.50 50.00
INTR-INTR-INTERPRETER 42 284.25 8617.50 30.32
OCCT-97530-OT SESSION BY LICENSED OT 63 263.00 17241.20 65.56
OCCT-97530HM-OT SESSION BY OT ASST 3 6.75 363.08 53.79
PHY-97110-PT SESSION BY LICENSED PT 79 394.25 26349.41 66.83
RSPT-RSPT-RESPITE 1 53.00 424.00 8.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 380 1938.50 122688.57 63.29
SPL-92508-GROUP SPL SESSION PER CHILD 20 149.25 944.51 6.33
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 943 190170 101026.46 0.53
Subtotal (Total Children Is Unduplicated) 1047 195191 350550.59 1.80
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Total 199184.00 509114.91 2.56
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Number of Children (Unduplicated) With at Least One Service 1846
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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 0 0.00 0.00 0.00
P 9163 188423.25 361491.02 361491.02
D 3 3.00 150.00 0.00
S 200 151.00 5587.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5929 10583.75 140340.38 0.00
Other 19 23.00 1546.51 0.00
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Total 15314 199184.00 509114.91 361491.02