CMS/EIP Fiscal Report Center: 09
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 765 754.50 27916.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 725 753.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 651 647.00 23939.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1630 5123.75 189467.75 36.98
TCON-TCON-TRANSITION CONFERENCE 172 172.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1733 7450.25 241323.25 32.39
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 60 96.50 7237.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 11.50 862.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 20 25.50 1912.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 31 59.00 4425.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 38.00 2109.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 241 322.00 24150.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 57 90.50 6787.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 150 183.00 13725.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 177 266.00 14763.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 63.00 4725.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.00 194.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 3.00 150.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 432 1169.00 81397.50 69.63
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 64.75 3237.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 19 41.50 2075.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 28 32.50 1625.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 66.00 3300.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 13.50 675.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 105 530.00 26500.00 50.00
INTR-INTR-INTERPRETER 15 53.00 2650.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 77 491.50 33363.02 67.88
PHY-97110-PT SESSION BY LICENSED PT 33 166.25 11285.05 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 111.25 7551.65 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 253 24520.0 12260.00 0.50
Subtotal (Total Children Is Unduplicated) 263 26091.3 104572.22 4.01
----------------------------------------------------------------------------------------------------------------
Total 34710.50 427292.97 12.31
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1759
----------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 35 22.75 841.75 0.00
U 0 0.00 0.00 0.00
B 603 496.75 24738.78 261.50
P 11779 32559.75 320002.84 403320.59
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
1603 1629.25 81635.60 0.00
Other 6 2.00 74.00 0.00
-------------------------------------------------
Total 14026 34710.50 427292.97 403582.09