CMS/EIP Fiscal Report Center: 54
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 628 2028.25 74777.00 36.87
Subtotal (Total Children Is Unduplicated) 628 2028.25 74777.00 36.87
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 125.00 125.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.50 337.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 5.00 375.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 5.00 277.50 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 31.50 2362.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 29.50 1637.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 40 49.50 3712.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 75 127.00 8875.75 69.89
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 83 433.25 21662.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 3.00 150.00 50.00
Subtotal (Total Children Is Unduplicated) 84 436.25 21812.50 50.00
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Total 2591.50 105465.25 40.70
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Number of Children (Unduplicated) With at Least One Service 641
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Center 54
Flag Claims Units Chgs Paid
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R 3 1.75 64.75 0.00
U 0 0.00 0.00 0.00
B 1103 937.25 44332.25 0.00
P 2517 1627.75 60014.00 60014.00
D 0 0.00 0.00 0.00
S 1 0.50 18.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
30 22.75 980.25 0.00
Other 2 1.50 55.50 0.00
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Total 3656 2591.50 105465.25 60014.00