CMS/EIP Fiscal Report Center: 52
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 417 227.75 8426.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 421 538.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 315 253.75 9388.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 714 2091.00 76719.50 36.69
TCON-TCON-TRANSITION CONFERENCE 77 77.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 723 3187.50 94535.00 29.66
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 4 6.25 312.50 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.00 166.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 72 123.50 9262.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.50 262.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 21.50 1612.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 89 150.00 8325.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 32.50 2437.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 5 5.00 250.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 18 18.00 873.00 48.50
Subtotal (Total Children Is Unduplicated) 148 370.75 23958.50 64.62
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 4.00 1949.95 487.49
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 28 29.00 1450.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 14 8.75 437.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 1.25 31.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.00 50.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.50 25.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 2.75 137.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.50 37.50 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 12.50 625.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 90 356.50 17825.00 50.00
INTR-INTR-INTERPRETER 1 1.50 37.50 25.00
OCCT-97530-OT SESSION BY LICENSED OT 14 104.75 7110.43 67.88
PHY-97110-PT SESSION BY LICENSED PT 10 28.25 1917.61 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 60 283.50 19243.98 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 246 32582.0 16291.00 0.50
Subtotal (Total Children Is Unduplicated) 247 33419.3 67231.72 2.01
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Total 36977.50 185725.22 5.02
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Number of Children (Unduplicated) With at Least One Service 730
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Center 52
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 2181 1501.75 66621.29 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 19 21.00 1112.57 0.00
H 82 154.75 10006.57 0.00
T 0 0.00 0.00 0.00
4614 35300.00 107984.79 0.00
Other 0 0.00 0.00 0.00
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Total 6896 36977.50 185725.22 0.00