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
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 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 685 722.25 26723.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 897 2878.75 106495.25 36.99
TCON-TCON-TRANSITION CONFERENCE 187 286.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1580 5474.00 163040.50 29.78
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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 16 30.00 2250.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 17.00 1275.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 12.50 693.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 69 104.00 7800.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 35.50 2662.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 35 44.50 3337.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 57 97.00 5383.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 6.00 450.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 121 358.00 24552.25 68.58
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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 61 337.00 16850.00 50.00
INTR-INTR-INTERPRETER 11 6.50 325.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 16 88.75 6024.35 67.88
PHY-97110-PT SESSION BY LICENSED PT 5 13.00 882.44 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.00 100.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 45.25 3071.57 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 256 36589.0 18294.50 0.50
Subtotal (Total Children Is Unduplicated) 275 37346.3 58766.96 1.57
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Total 43178.25 246359.71 5.71
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Number of Children (Unduplicated) With at Least One Service 1615
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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 0 0.00 0.00 0.00
P 6581 26564.25 161169.84 161169.84
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
99 399.50 2661.13 0.00
Other 0 0.00 0.00 0.00
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Total 10072 43178.25 246359.71 243698.58