CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 885 806.00 29822.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 731 781.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 685 723.25 26760.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1623 5145.50 190239.25 36.97
TCON-TCON-TRANSITION CONFERENCE 188 287.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1756 7742.75 246821.50 31.88
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 4 4.50 225.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 64 107.00 8025.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 17.00 1275.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 21 25.00 1875.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 33 62.00 4650.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 27.50 1526.25 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 8 8.00 444.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 248 338.50 25387.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 110.00 8250.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 154 185.50 13912.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 169 259.50 14402.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 51 62.00 4650.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 5 5.00 250.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 448 1217.50 85163.50 69.95
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 71 88.75 4437.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 21 37.75 1887.50 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 37.50 1875.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 62.25 3112.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 36.00 1800.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.00 100.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 120 645.25 32262.50 50.00
INTR-INTR-INTERPRETER 11 6.50 325.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 59 378.00 25658.64 67.88
PHY-97110-PT SESSION BY LICENSED PT 33 164.00 11132.32 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.00 100.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 141.00 9571.08 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 256 36614.0 18307.00 0.50
Subtotal (Total Children Is Unduplicated) 276 38215.5 110575.64 2.89
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Total 47175.75 442560.64 9.38
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Number of Children (Unduplicated) With at Least One Service 1780
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Center 09
Flag Claims Units Chgs Paid
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R 6 7.75 286.75 0.00
U 0 0.00 0.00 0.00
B 825 745.00 35047.57 204.26
P 9468 29017.25 271503.36 271374.61
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 3392 16214.50 82528.74 82528.74
783 1191.25 53194.22 46.25
Other 0 0.00 0.00 0.00
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Total 14474 47175.75 442560.64 354153.86