CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 Page: 1
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 777 787.00 29119.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 698 801.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 634 648.25 23985.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1519 4520.00 167230.75 37.00
TCON-TCON-TRANSITION CONFERENCE 121 122.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1658 6878.25 220335.00 32.03
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.75 137.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 12 22.50 1125.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 55.50 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 71 124.50 9263.50 74.41
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 19 32.00 2400.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 21 28.00 2100.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 33 66.50 4987.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 33.00 1831.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 4 4.00 222.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 308 502.50 37687.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 94 164.00 12300.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 149 207.00 15484.34 74.80
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 169 286.00 15873.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 88.00 6600.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.00 194.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 3 3.00 150.00 50.00
Subtotal (Total Children Is Unduplicated) 467 1572.75 110605.34 70.33
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 1145.50 1145.50
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 108 132.50 6625.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 2.00 50.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 12 25.75 1287.50 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 49 49.25 2462.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 23 51.50 2575.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 37 56.75 2837.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 441 3388.00 168340.00 49.69
INTR-INTR-INTERPRETER 12 12.00 600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 392 2706.50 179567.62 66.35
PHY-97110-PT SESSION BY LICENSED PT 337 2058.25 136142.55 66.14
PHY-97110HM-PT SESSION BY PT ASST 9 67.00 3639.44 54.32
SENS-V5264-EARMOLD 5 10.00 187.20 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 670 4659.50 314496.60 67.50
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 831 214614 107307.00 0.50
Subtotal (Total Children Is Unduplicated) 1256 227835 927313.41 4.07
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Total 236286.00 1258253.75 5.33
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Number of Children (Unduplicated) With at Least One Service 1935
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Center 09
Flag Claims Units Chgs Paid
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R 13 12.00 444.00 27.75
U 0 0.00 0.00 0.00
B 938 874.50 44230.89 335.00
P 10942 142181.50 536891.27 540385.21
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 0.50 18.50 18.50
T 4773 81620.50 260909.16 260909.16
3559 11597.00 415759.93 1989.75
Other 0 0.00 0.00 0.00
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Total 20226 236286.00 1258253.75 803665.37