CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Eligibility Filter:DEI Only
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 14 7.00 259.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 18 18.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 23 22.75 841.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 81 176.00 6512.00 37.00
Subtotal (Total Children Is Unduplicated) 81 223.75 7612.75 34.02
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 12.50 937.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 11.50 862.50 75.00
Subtotal (Total Children Is Unduplicated) 9 24.00 1800.00 75.00
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 27.00 1350.00 50.00
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
PHY-97110-PT SESSION BY LICENSED PT 2 3.00 203.64 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 16.50 1088.02 65.94
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 982.00 491.00 0.50
Subtotal (Total Children Is Unduplicated) 8 1030.50 3249.66 3.15
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Total 1278.25 12662.41 9.91
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Number of Children (Unduplicated) With at Least One Service 81
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Center 06
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 137 98.25 3635.25 0.00
P 119 739.25 2865.91 2865.91
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
215 440.75 6161.25 9.25
Other 0 0.00 0.00 0.00
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Total 471 1278.25 12662.41 2875.16