CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Eligibility Filter:Not Part C
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 14 5.25 194.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 53 53.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 30 21.25 786.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 62 282.25 10443.25 37.00
Subtotal (Total Children Is Unduplicated) 64 361.75 11423.75 31.58
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 3.00 166.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 48.00 3600.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 67.00 3718.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 10.50 787.50 75.00
Subtotal (Total Children Is Unduplicated) 58 131.50 8497.50 64.62
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EI Services,Class #03
PHY-97110-PT SESSION BY LICENSED PT 1 2.00 135.76 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.00 67.88 67.88
Subtotal (Total Children Is Unduplicated) 1 3.00 203.64 67.88
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Total 496.25 20124.89 40.55
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Number of Children (Unduplicated) With at Least One Service 64
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Center 57
Flag Claims Units Chgs Paid
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R 17 25.00 1000.00 0.00
U 0 0.00 0.00 0.00
B 16 20.25 1109.25 0.00
P 96 127.25 5194.75 5194.75
D 14 17.75 750.75 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
272 306.00 12070.14 0.00
Other 0 0.00 0.00 0.00
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Total 415 496.25 20124.89 5194.75