CMS/EIP Fiscal Report Center: 09
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 47 30.50 1128.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5 5.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 114 86.00 3182.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 215 484.75 17935.75 37.00
Subtotal (Total Children Is Unduplicated) 216 606.25 22246.25 36.69
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 17.50 1312.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 6.00 450.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 9.50 527.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.00 55.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 134 172.00 12900.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 66.50 4987.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 85 98.00 7305.00 74.54
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 83 124.00 6882.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 23.00 1725.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 7 7.00 350.00 50.00
Subtotal (Total Children Is Unduplicated) 199 529.50 36869.75 69.63
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 0.25 12.50 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 41 2310.00 1155.00 0.50
Subtotal (Total Children Is Unduplicated) 41 2310.25 1167.50 0.51
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Total 3446.00 60283.50 17.49
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Number of Children (Unduplicated) With at Least One Service 236
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Center 09
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 74 88.25 4550.25 0.00
P 664 1872.25 36382.00 36287.00
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 194 1157.50 7903.25 7903.25
136 328.00 11448.00 0.00
Other 0 0.00 0.00 0.00
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Total 1068 3446.00 60283.50 44190.25