CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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 82 39.50 1461.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 136 162.00 5994.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 222 908.00 33596.00 37.00
Subtotal (Total Children Is Unduplicated) 222 1109.50 41051.50 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.50 138.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 81 110.50 8287.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 13.00 975.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 68 91.50 5078.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 62.50 4687.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 128 285.50 19553.00 68.49
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 41 1656.00 828.00 0.50
Subtotal (Total Children Is Unduplicated) 41 1657.00 878.00 0.53
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Total 3052.00 61482.50 20.14
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Number of Children (Unduplicated) With at Least One Service 228
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Center 01
Flag Claims Units Chgs Paid
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R 19 22.75 1424.25 0.00
U 0 0.00 0.00 0.00
B 200 170.25 6582.25 0.00
P 217 1338.00 11298.75 11298.75
D 46 50.50 3563.25 0.00
S 251 242.25 8963.25 0.00
H 9 10.00 652.50 0.00
T 39 454.50 2874.75 2874.75
878 633.75 23957.25 0.00
Other 24 130.00 2166.25 0.00
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Total 1683 3052.00 61482.50 14173.50