CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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 210 103.25 3820.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 152 165.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 175 257.75 9490.50 36.82
TCM-T1017TL-TARGETED CASE MANAGEMENT 207 455.25 16761.00 36.82
TCON-TCON-TRANSITION CONFERENCE 24 24.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 446 1005.25 30071.75 29.91
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 28 48.75 2437.50 50.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 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 30 55.50 4117.50 74.19
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 20.50 1481.92 72.29
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 9.00 675.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 36 66.00 3660.75 55.47
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.00 900.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 78.02 39.01
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 85 222.25 13826.44 62.21
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.00 696.79 232.26
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 12.25 612.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 12 12.75 637.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 1.00 25.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 9.00 435.00 48.33
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 10.75 537.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.25 31.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 69 419.75 20946.50 49.90
INTR-INTR-INTERPRETER 5 9.25 452.50 48.92
OCCT-97530-OT SESSION BY LICENSED OT 30 231.50 8966.01 38.73
PHY-97110-PT SESSION BY LICENSED PT 10 42.00 2742.62 65.30
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 51 372.75 24568.72 65.91
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 278 81188.0 40518.30 0.50
Subtotal (Total Children Is Unduplicated) 292 82313.3 101170.19 1.23
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Total 83540.75 145068.38 1.74
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Number of Children (Unduplicated) With at Least One Service 549
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Center 02
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 0 0.00 0.00 0.00
T 1713 58561.25 82599.79 82599.79
1638 24979.50 62468.59 0.00
Other 0 0.00 0.00 0.00
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Total 3351 83540.75 145068.38 82599.79