CMS/EIP Fiscal Report Center: 55
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 172 83.25 3071.00 36.89
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 289 376.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 89 67.75 2488.25 36.73
TCM-T1017TL-TARGETED CASE MANAGEMENT 261 804.00 29526.00 36.72
TCON-TCON-TRANSITION CONFERENCE 34 34.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 453 1365.00 35085.25 25.70
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 8 15.00 962.50 64.17
EXIT-EXIT-TRANSITION ASSESSMENT 8 12.50 900.00 72.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.50 262.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 58.70 4402.56 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 18.50 1387.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 16.67 1250.19 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 20.50 1137.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 26.50 1987.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 12.00 582.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 0.02 1.14 57.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 1.36 66.00 48.53
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 9.07 440.00 48.51
Subtotal (Total Children Is Unduplicated) 103 197.82 13642.14 68.96
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.75 87.50 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 4.00 200.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 5 31.00 1550.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 32 148.50 7425.00 50.00
INTR-INTR-INTERPRETER 2 24.50 1095.50 44.71
OCCT-97530-OT SESSION BY LICENSED OT 62 278.68 18910.91 67.86
OCCT-97530HM-OT SESSION BY OT ASST 4 5.00 271.60 54.32
PHY-97110-PT SESSION BY LICENSED PT 42 194.98 13238.02 67.89
PHY-97110HM-PT SESSION BY PT ASST 6 8.75 475.30 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 128 735.11 49897.30 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 276 61705.0 46395.22 0.75
Subtotal (Total Children Is Unduplicated) 323 63137.3 139546.35 2.21
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Total 64700.09 188273.74 2.91
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Number of Children (Unduplicated) With at Least One Service 563
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Center 55
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 2709 34705.59 86520.09 86520.09
D 44 47.25 1862.25 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 2035 28568.17 62383.95 62383.95
1629 1379.08 37507.45 0.00
Other 0 0.00 0.00 0.00
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Total 6417 64700.09 188273.74 148904.04