CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Agency Filter:EXT
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 30 29.00 1073.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 131 269.50 9971.50 37.00
Subtotal (Total Children Is Unduplicated) 140 298.50 11044.50 37.00
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 5.00 250.00 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 8 8.00 388.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 18 18.00 873.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 12 12.00 582.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 10 10.00 485.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 35 35.00 1697.50 48.50
Subtotal (Total Children Is Unduplicated) 79 89.00 4324.00 48.58
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 21 30.75 1537.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 76 148.00 7400.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 39 76.00 1900.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 22 38.00 1900.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 15 29.00 725.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 10.50 525.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 61 102.00 5100.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 25 47.00 1175.00 25.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 83 2706.00 67650.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 48 1915.00 47875.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 556 3781.75 189087.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 132 631.50 42866.22 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 102 484.70 32904.10 67.89
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 4 6.00 300.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 158 783.64 53193.49 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.00 26.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 584 107219 53609.50 0.50
Subtotal (Total Children Is Unduplicated) 781 118012 507856.19 4.30
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Total 118399.84 523224.69 4.42
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Number of Children (Unduplicated) With at Least One Service 787
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Center 04
Flag Claims Units Chgs Paid
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R 1 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 117 102.75 3801.75 0.00
P 2590 109628.02 188815.51 188816.78
D 9 131.00 1036.48 1056.82
S 0 0.00 0.00 0.00
H 834 2617.82 136037.76 136280.12
T 0 0.00 0.00 0.00
1010 5919.25 193496.19 0.00
Other 0 0.00 0.00 0.00
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Total 4561 118399.84 523224.69 326153.72