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:Program Patients
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 783 363.50 13449.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 683 704.25 26057.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1141 3082.00 114008.25 36.99
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1791 4150.75 153515.00 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 4 10.50 525.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 46 71.50 3575.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 11.50 862.50 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 2 3.50 262.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 12.50 693.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 106 146.00 10859.51 74.38
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 15.00 966.81 64.45
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 39.00 2925.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 139.00 7714.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 62 81.00 6075.00 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) 265 538.50 34872.07 64.76
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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 8 41.00 2050.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 14 45.00 2250.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 197 1094.75 54737.50 50.00
INTR-INTR-INTERPRETER 43 285.75 8692.50 30.42
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 381 1941.25 122875.24 63.30
SPL-92508-GROUP SPL SESSION PER CHILD 20 149.25 944.51 6.33
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 999 194513 103347.16 0.53
Subtotal (Total Children Is Unduplicated) 1104 199567 354582.96 1.78
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Total 204256.00 542970.03 2.66
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Number of Children (Unduplicated) With at Least One Service 2114
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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 9376 192674.00 371572.64 371572.64
D 4 4.00 225.00 0.00
S 258 206.25 7631.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
6702 11337.25 161200.38 0.00
Other 29 34.50 2340.76 0.00
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Total 16369 204256.00 542970.03 371572.64