CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Eligibility Filter:Not Part C
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 22 9.75 360.75 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 43 33.75 1248.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 64 212.25 7816.25 36.83
Subtotal (Total Children Is Unduplicated) 64 255.75 9425.75 36.86
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.50 500.00 66.67
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.00 333.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 10 10.00 500.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 40.50 2869.00 70.84
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 15.50 1056.50 68.16
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 41.50 2303.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
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) 46 127.50 7997.75 62.73
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 33 1643.00 821.50 0.50
Subtotal (Total Children Is Unduplicated) 33 1643.00 821.50 0.50
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Total 2026.25 18245.00 9.00
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Number of Children (Unduplicated) With at Least One Service 65
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Center 52
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 151 127.00 5385.25 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 11 17.00 1060.50 0.00
T 0 0.00 0.00 0.00
347 1882.25 11799.25 0.00
Other 0 0.00 0.00 0.00
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Total 509 2026.25 18245.00 0.00