CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
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 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 351 931.25 34289.75 36.82
TCON-TCON-TRANSITION CONFERENCE 89 89.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 638 1871.75 49728.00 26.57
----------------------------------------------------------------------------------------------------------------
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 1 1.50 112.50 75.00
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 1 1.00 48.50 48.50
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 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 10 13.50 933.00 69.11
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.00 198.50 66.17
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 11.00 745.50 67.77
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 31.50 1748.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 9.00 436.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.00 533.50 48.50
Subtotal (Total Children Is Unduplicated) 76 126.00 7099.00 56.34
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 56 61.50 3075.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 10 11.25 562.50 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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 59 310.01 15500.03 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 5.00 250.00 50.00
INTR-INTR-INTERPRETER 1 2.75 137.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 26 182.17 12365.08 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 4.50 244.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 37 182.41 12371.72 67.82
PHY-97110HM-PT SESSION BY PT ASST 1 2.50 135.80 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 3.50 175.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 96 509.89 34611.04 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 488 115820 57908.50 0.50
Subtotal (Total Children Is Unduplicated) 512 117116 138311.61 1.18
----------------------------------------------------------------------------------------------------------------
Total 119113.98 195138.61 1.64
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 711
----------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
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 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 2 2.50 133.25 0.00
T 23 1205.00 1442.68 1504.68
5696 117906.48 193562.68 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5721 119113.98 195138.61 1504.68