CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:GR
Eligibility Filter:Not Part C
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 73 49.25 1822.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 53 85.00 3145.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 89 251.00 9287.00 37.00
Subtotal (Total Children Is Unduplicated) 119 385.25 14254.25 37.00
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Screening, Eval, and Assessment,Class #02
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 5.00 375.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.00 825.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 35.00 1941.50 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 29 75.50 5662.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 6 6.00 300.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 43 140.00 9587.00 68.48
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 1.50 75.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 5.00 339.40 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 26 1723.00 861.50 0.50
Subtotal (Total Children Is Unduplicated) 30 1729.50 1275.90 0.74
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Total 2254.75 25117.15 11.14
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Number of Children (Unduplicated) With at Least One Service 119
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Center 07
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 45 633.00 3209.65 3209.65
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
602 1621.75 21907.50 0.00
Other 0 0.00 0.00 0.00
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Total 647 2254.75 25117.15 3209.65