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
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
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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 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-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 10.50 787.50 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 5 8.00 600.00 75.00
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 5 5.00 242.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 37 75.00 4585.00 61.13
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 30.75 1537.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 6 5.75 287.50 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 28 88.59 4429.11 50.00
OCCT-97530-OT SESSION BY LICENSED OT 8 36.75 2494.59 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 4.50 244.44 54.32
PHY-97110-PT SESSION BY LICENSED PT 3 12.50 848.50 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 2.50 135.80 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 42.86 2909.34 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 217 29546.0 14771.50 0.50
Subtotal (Total Children Is Unduplicated) 217 29777.2 27989.53 0.94
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Total 31723.95 82302.53 2.59
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Number of Children (Unduplicated) With at Least One Service 661
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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 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 0 0.00 0.00 0.00
4070 31721.45 82169.28 0.00
Other 0 0.00 0.00 0.00
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Total 4072 31723.95 82302.53 0.00