CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 2008 5709.25 211216.50 37.00
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2046 6618.75 244831.00 36.99
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 9.50 475.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 8 10.50 525.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.50 637.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 11.50 627.25 54.54
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 65 86.50 6487.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 127.50 7076.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 72 92.50 6937.50 75.00
Subtotal (Total Children Is Unduplicated) 165 352.50 23216.00 65.86
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.50 125.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.50 75.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 59.00 2950.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 5.00 250.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.00 120.00 60.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 39.00 19.50 0.50
Subtotal (Total Children Is Unduplicated) 22 109.00 3539.50 32.47
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Total 7080.25 271586.50 38.36
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Number of Children (Unduplicated) With at Least One Service 2056
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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 309 201.75 7464.75 7464.70
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
5761 3722.75 140235.25 0.00
Other 236 280.00 16850.25 0.00
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Total 10255 7080.25 271586.50 7464.70