CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 984 844.50 31218.75 36.97
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 392 413.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 543 746.75 27620.50 36.99
TCM-T1017TL-TARGETED CASE MANAGEMENT 1453 4728.50 174688.75 36.94
TCON-TCON-TRANSITION CONFERENCE 55 55.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1521 6787.75 233528.00 34.40
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 6.00 300.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 9 26.00 1300.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 11.50 862.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.50 416.25 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 59 116.50 6438.00 55.26
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 190 562.00 42000.00 74.73
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.00 50.00 50.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 28 28.00 1400.00 50.00
Subtotal (Total Children Is Unduplicated) 231 762.50 53057.87 69.58
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.25 12.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 21 7.50 375.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 88 5912.00 2956.00 0.50
Subtotal (Total Children Is Unduplicated) 103 5919.75 3343.50 0.56
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Total 13470.00 289929.37 21.52
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Number of Children (Unduplicated) With at Least One Service 1521
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Center 07
Flag Claims Units Chgs Paid
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R 18 22.75 1278.75 0.00
U 0 0.00 0.00 0.00
B 3552 2440.25 98103.78 0.00
P 229 246.75 13279.75 13279.75
D 0 0.00 0.00 0.00
S 201 114.50 4349.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8123 10645.75 172917.59 0.00
Other 0 0.00 0.00 0.00
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Total 12123 13470.00 289929.37 13279.75