CMS/EIP Fiscal Report Center: 57
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 6 4.00 148.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 36 38.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 21 15.50 573.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 46 196.00 7252.00 37.00
Subtotal (Total Children Is Unduplicated) 51 253.50 7973.50 31.45
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 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 28 30.50 2287.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 34 50.50 2747.25 54.40
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 7.00 525.00 75.00
Subtotal (Total Children Is Unduplicated) 37 94.00 5926.25 63.05
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Total 347.50 13899.75 40.00
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Number of Children (Unduplicated) With at Least One Service 51
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Center 57
Flag Claims Units Chgs Paid
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R 3 5.75 212.75 0.00
U 0 0.00 0.00 0.00
B 30 43.00 2111.25 0.00
P 95 117.75 5123.75 5123.75
D 6 5.50 288.25 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
152 175.50 6163.75 0.00
Other 0 0.00 0.00 0.00
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Total 286 347.50 13899.75 5123.75