CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/16/2009 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 24 18.00 666.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 3 3.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 55 39.75 1470.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 184 361.00 13357.00 37.00
Subtotal (Total Children Is Unduplicated) 187 421.75 15493.75 36.74
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 9.00 675.00 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 6 8.00 600.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.00 150.00 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 116 156.00 11592.00 74.31
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 35 48.00 3562.50 74.22
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 68 85.50 6245.50 73.05
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 60 83.50 4634.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 28.00 2100.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 9 12.00 600.00 50.00
Subtotal (Total Children Is Unduplicated) 159 438.00 30550.75 69.75
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 13 605.00 302.50 0.50
Subtotal (Total Children Is Unduplicated) 13 605.00 302.50 0.50
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Total 1464.75 46347.00 31.64
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Number of Children (Unduplicated) With at Least One Service 217
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Center 09
Flag Claims Units Chgs Paid
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R 2 4.00 185.00 0.00
U 0 0.00 0.00 0.00
B 86 109.00 5946.75 0.00
P 505 834.25 26202.50 26358.49
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 93 386.75 4754.50 4754.50
98 130.75 9258.25 0.00
Other 0 0.00 0.00 0.00
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Total 784 1464.75 46347.00 31112.99