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
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 9 16.00 1200.00 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 3 5.00 375.00 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 63 119.50 8962.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 31.00 2325.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 14.50 1087.50 75.00
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
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
Subtotal (Total Children Is Unduplicated) 102 331.75 22178.75 66.85
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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 55 318.75 15937.50 50.00
INTR-INTR-INTERPRETER 12 12.00 600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 11 34.00 2307.92 67.88
PHY-97110-PT SESSION BY LICENSED PT 7 18.50 1255.78 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 90.50 6143.14 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 238 37014.0 18507.00 0.50
Subtotal (Total Children Is Unduplicated) 265 37689.8 54801.34 1.45
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Total 42917.25 223962.59 5.22
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Number of Children (Unduplicated) With at Least One Service 1486
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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 5779 28704.50 141986.82 141928.94
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 3047 11437.50 75468.56 75468.56
238 2775.25 6507.21 30.00
Other 0 0.00 0.00 0.00
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Total 9064 42917.25 223962.59 217427.50