CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 Page: 1
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 195 83.50 3080.25 36.89
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 138 139.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 145 229.25 8473.00 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 149 317.00 11581.00 36.53
TCON-TCON-TRANSITION CONFERENCE 25 25.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 398 793.75 23134.25 29.15
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 23 43.50 2175.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 28.00 1990.00 71.07
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 20.00 1472.21 73.61
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 31.00 1720.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.50 412.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 55 131.00 7915.71 60.43
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.00 136.83 45.61
AUD-HA_FUP-AUDIOLOGY SERVICES 1 2.00 55.38 27.69
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 12.25 612.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 15 14.00 700.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 7.75 387.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 8.00 400.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.50 12.50 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 70 439.50 21975.00 50.00
INTR-INTR-INTERPRETER 4 10.00 500.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 27 131.00 8696.84 66.39
PHY-97110-PT SESSION BY LICENSED PT 7 24.75 1528.82 61.77
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 266.25 17576.64 66.02
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 292 79610.0 39805.00 0.50
Subtotal (Total Children Is Unduplicated) 307 80530.3 92418.26 1.15
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Total 81455.00 123468.22 1.52
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Number of Children (Unduplicated) With at Least One Service 514
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Center 02
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 0 0.00 0.00 0.00
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 1804 69098.75 84223.71 84223.71
1228 12356.25 39244.51 0.00
Other 0 0.00 0.00 0.00
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Total 3032 81455.00 123468.22 84223.71