CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Agency Filter:EIP DEI DEIP
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
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 7 9.50 475.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.00 600.00 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 1.50 112.50 75.00
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-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 50 83.00 6225.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 21.50 1612.50 75.00
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 18 27.00 2025.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 8 8.00 389.90 48.74
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 13.00 630.50 48.50
Subtotal (Total Children Is Unduplicated) 128 307.00 19713.40 64.21
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 27 32.50 1625.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 8 7.50 375.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.00 50.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 5.25 262.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.50 12.50 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 79 332.25 16624.99 50.04
OCCT-97530-OT SESSION BY LICENSED OT 14 83.25 5651.01 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 4.50 244.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 7 19.50 1323.66 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 2.50 135.80 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 68 251.50 17073.41 67.89
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 218 29756.0 14876.50 0.50
Subtotal (Total Children Is Unduplicated) 219 30496.5 58261.06 1.91
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Total 33547.75 159864.71 4.77
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Number of Children (Unduplicated) With at Least One Service 709
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Center 52
Flag Claims Units Chgs Paid
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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 0 0.00 0.00 0.00
4270 32222.61 100316.99 173.78
Other 0 0.00 0.00 0.00
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Total 6243 33547.75 159864.71 234.19