CMS/EIP Fiscal Report Center: 09
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 777 786.25 29091.25 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 831 2538.25 93906.00 37.00
TCON-TCON-TRANSITION CONFERENCE 121 122.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1447 4895.75 146982.50 30.02
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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 11 20.50 1025.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 17.00 1275.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.00 300.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.00 450.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 12.00 666.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 69 130.50 9787.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 37.00 2775.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 28.50 2096.84 73.57
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 95.50 5300.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.00 450.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 109 366.75 24711.59 67.38
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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 232 1915.50 94715.00 49.45
INTR-INTR-INTERPRETER 12 12.00 600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 181 1229.25 79291.89 64.50
PHY-97110-PT SESSION BY LICENSED PT 143 795.00 50393.14 63.39
PHY-97110HM-PT SESSION BY PT ASST 2 1.00 54.32 54.32
SENS-V5264-EARMOLD 5 10.00 187.20 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 424 3108.25 209197.75 67.30
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 831 214584 107292.00 0.50
Subtotal (Total Children Is Unduplicated) 1065 221975 558764.30 2.52
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Total 227237.25 730458.39 3.21
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Number of Children (Unduplicated) With at Least One Service 1728
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Center 09
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 8426 139971.50 434354.68 434296.80
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 4773 81620.50 260909.16 260909.16
498 5645.25 35194.55 1989.75
Other 0 0.00 0.00 0.00
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Total 13697 227237.25 730458.39 697195.71