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
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 762 750.25 27759.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 725 753.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 650 645.50 23883.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 931 3000.75 110916.75 36.96
TCON-TCON-TRANSITION CONFERENCE 171 171.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1535 5320.50 162559.50 30.55
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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 34 58.50 4387.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 6.50 487.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 11.00 825.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 17 34.00 2550.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 23.50 1304.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 150 200.00 15000.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 50.50 3787.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 95 114.00 8550.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 87 129.50 7187.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 51.00 3825.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 261 684.50 48199.50 70.42
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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 32.25 1612.50 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 55 275.75 13787.50 50.00
INTR-INTR-INTERPRETER 15 53.00 2650.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 26 119.25 8094.69 67.88
PHY-97110-PT SESSION BY LICENSED PT 9 37.00 2511.56 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 40.00 2715.20 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 253 24520.0 12260.00 0.50
Subtotal (Total Children Is Unduplicated) 263 25264.0 52968.95 2.10
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Total 31269.00 263727.95 8.43
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Number of Children (Unduplicated) With at Least One Service 1573
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Center 09
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 9354 30545.25 228894.20 229319.70
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
626 723.75 34833.75 0.00
Other 0 0.00 0.00 0.00
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Total 9980 31269.00 263727.95 229319.70