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: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 378 202.00 7474.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 362 434.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 280 215.50 7964.25 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 684 1803.75 66452.00 36.84
TCON-TCON-TRANSITION CONFERENCE 89 89.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 700 2744.25 81890.25 29.84
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 7 10.50 525.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 3.00 150.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 14.50 972.00 67.03
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.50 161.00 64.40
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.50 337.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.00 555.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 23 23.00 1150.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 88 132.00 8865.00 67.16
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 9.50 441.00 46.42
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 31 41.50 2629.00 63.35
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 72 116.50 6438.00 55.26
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 28.00 2100.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 22 25.00 1214.40 48.58
PSTH-97001-EVAL BY LICENSED PT, INITIAL 12 12.00 582.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 42 42.00 2037.00 48.50
Subtotal (Total Children Is Unduplicated) 192 477.00 28319.40 59.37
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 59 67.75 3387.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 16 15.50 775.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 3.50 175.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 3.50 175.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 4 1.75 43.75 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 9 11.25 562.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.50 12.50 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 60 419.50 12615.00 30.07
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 150 875.25 42375.99 48.42
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 23.00 1150.00 50.00
INTR-INTR-INTERPRETER 1 2.75 137.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 100 685.94 46560.65 67.88
OCCT-97530HM-OT SESSION BY OT ASST 3 9.00 488.88 54.32
PHY-97110-PT SESSION BY LICENSED PT 122 808.56 54874.09 67.87
PHY-97110HM-PT SESSION BY PT ASST 3 4.00 217.28 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 3.50 175.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 311 1520.91 103206.95 67.86
SPL-92508-GROUP SPL SESSION PER CHILD 5 30.00 396.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 489 117176 58661.50 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 9 36.25 1812.50 50.00
Subtotal (Total Children Is Unduplicated) 539 121699 327808.84 2.69
----------------------------------------------------------------------------------------------------------------
Total 124919.91 438018.49 3.51
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 750
----------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 5.00 375.00 0.00
U 0 0.00 0.00 0.00
B 1893 1215.25 52925.57 0.00
P 1 0.89 60.41 60.41
D 0 0.00 0.00 0.00
S 24 20.50 1043.50 0.00
H 52 83.50 5143.24 0.00
T 23 1205.00 1442.68 1504.68
7105 122389.77 377028.09 173.78
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 9101 124919.91 438018.49 1738.87