CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/16/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 68 119.50 8888.50 74.38
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 18 23.00 1725.00 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 276 448.50 33637.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 89 157.00 11775.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 116 151.00 11325.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 168 284.00 15762.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 88.00 6600.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 452 1434.75 100572.00 70.10
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 79 96.50 4825.00 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 19 30.75 1537.50 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 14.50 725.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 32.50 1625.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 114 639.25 31962.50 50.00
INTR-INTR-INTERPRETER 12 12.00 600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 58 254.25 17258.49 67.88
PHY-97110-PT SESSION BY LICENSED PT 30 151.00 10249.88 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 138.75 9418.35 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 238 37044.0 18522.00 0.50
Subtotal (Total Children Is Unduplicated) 267 38441.3 98061.22 2.55
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Total 46754.25 418968.22 8.96
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Number of Children (Unduplicated) With at Least One Service 1693
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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 8268 30850.50 240179.09 240061.46
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 3047 11437.50 75468.56 75468.56
879 3579.25 58627.18 30.00
Other 0 0.00 0.00 0.00
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Total 13146 46754.25 418968.22 315941.27