CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Payclass Filters:GR
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 55 37.75 1396.75 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 55 84.75 3135.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 70 191.50 7085.50 37.00
Subtotal (Total Children Is Unduplicated) 94 314.00 11618.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.50 412.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.00 300.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 21.50 1193.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 59.50 4462.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
Subtotal (Total Children Is Unduplicated) 26 91.50 6418.25 70.14
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.00 67.88 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 26 1674.00 837.00 0.50
Subtotal (Total Children Is Unduplicated) 27 1675.00 904.88 0.54
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Total 2080.50 18941.13 9.10
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Number of Children (Unduplicated) With at Least One Service 95
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Center 07
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 31 1133.00 2162.13 2162.13
D 0 0.00 0.00 0.00
S 9 7.75 286.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
490 939.75 16492.25 0.00
Other 0 0.00 0.00 0.00
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Total 530 2080.50 18941.13 2162.13