CMS/EIP Fiscal Report Center: 10
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 6 2.25 83.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 769 871.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 768 897.75 33216.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1136 3989.00 147593.00 37.00
TCON-TCON-TRANSITION CONFERENCE 218 218.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1664 5978.00 180893.00 30.26
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 10.50 787.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.00 675.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.00 675.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.50 749.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 68.00 5100.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 34 61.00 4575.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 37.50 2812.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 39 73.50 4079.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 33.50 2512.50 75.00
Subtotal (Total Children Is Unduplicated) 69 315.50 21966.00 69.62
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 0.75 50.91 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 60.00 30.00 0.50
Subtotal (Total Children Is Unduplicated) 1 61.75 130.91 2.12
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Total 6355.25 202989.91 31.94
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Number of Children (Unduplicated) With at Least One Service 1664
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Center 10
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 1 0.25 9.25 0.00
P 1 1.00 50.00 50.00
D 32 12.75 471.75 471.75
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8606 6341.25 202458.91 0.00
Other 0 0.00 0.00 0.00
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Total 8640 6355.25 202989.91 521.75