CMS/EIP Fiscal Report Center: 05
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 246 109.25 4042.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 263 264.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 338 325.75 12052.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 357 1082.75 40015.50 36.96
Subtotal (Total Children Is Unduplicated) 607 1781.75 56110.50 31.49
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 9 13.25 662.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 9 10.00 555.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 7.19 387.90 53.95
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 5.86 329.18 56.17
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 35.50 1970.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 20.50 1537.50 75.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 3.25 61.00 18.77
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 59 100.55 5793.33 57.62
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 65 61.75 3087.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 4 3.00 75.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 220 168.00 8400.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 11 4.25 106.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 39 16.50 825.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 65 27.25 1362.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 94 64.00 3200.00 50.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 6 9.50 237.50 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 167 792.24 30723.49 38.78
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 132 662.69 33024.07 49.83
INTR-INTR-INTERPRETER 7 44.75 2237.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 14 32.61 1953.58 59.91
PHY-97110-PT SESSION BY LICENSED PT 12 27.61 1664.69 60.29
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 58 187.62 12106.12 64.52
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 5.00 271.60 54.32
TRAN-TRAN-FAMILY TRANSPORTATION 1 12.00 229.62 19.14
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 395 87253.0 43626.50 0.50
Subtotal (Total Children Is Unduplicated) 426 89371.8 143130.92 1.60
----------------------------------------------------------------------------------------------------------------
Total 91254.07 205034.75 2.25
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 663
----------------------------------------------------------------------------------------------------------------
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
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 3248 88822.20 146196.89 146196.89
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
3124 2431.87 58837.86 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 6372 91254.07 205034.75 146196.89