CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
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 3 1.25 46.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 7.25 268.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 6 20.75 767.75 37.00
Subtotal (Total Children Is Unduplicated) 9 29.25 1082.25 37.00
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 4.00 400.37 100.09
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 10.00 500.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 1 6.25 424.25 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 24.00 1629.12 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 1622.00 741.00 0.46
Subtotal (Total Children Is Unduplicated) 6 1666.25 3694.74 2.22
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Total 1695.50 4776.99 2.82
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Number of Children (Unduplicated) With at Least One Service 11
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Center 51
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 36 1662.25 3294.37 3294.37
D 5 3.50 129.50 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
50 29.75 1353.12 0.00
Other 0 0.00 0.00 0.00
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Total 91 1695.50 4776.99 3294.37