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
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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 3.50 175.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 8 10.50 525.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.50 262.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.00 222.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 7.00 525.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 15.50 860.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 16.00 1200.00 75.00
Subtotal (Total Children Is Unduplicated) 34 60.00 3769.75 62.83
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.50 75.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 8.00 400.00 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) 13 50.50 614.50 12.17
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Total 3695.00 136948.00 37.06
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Number of Children (Unduplicated) With at Least One Service 1556
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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 0 0.00 0.00 0.00
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
5552 3526.00 130250.25 0.00
Other 13 15.00 960.75 0.00
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Total 5768 3695.00 136948.00 0.00