CMS/EIP Fiscal Report Center: 51
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
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 6 3.50 129.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.50 55.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 3.75 138.75 37.00
Subtotal (Total Children Is Unduplicated) 8 8.75 323.75 37.00
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Screening, Eval, and Assessment,Class #02
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 1 1.00 48.50 48.50
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 0.75 37.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 10.00 500.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 6.00 407.28 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 7.50 509.10 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 15.00 1018.20 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7 1104.00 522.00 0.47
Subtotal (Total Children Is Unduplicated) 7 1143.25 2994.08 2.62
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Total 1153.00 3366.33 2.92
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Number of Children (Unduplicated) With at Least One Service 10
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Center 51
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 40 1144.25 3042.58 3042.58
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 0 0.00 0.00 0.00
19 8.75 323.75 0.00
Other 0 0.00 0.00 0.00
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Total 59 1153.00 3366.33 3042.58