CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 1062 925.50 34225.00 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 824 1044.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 766 798.00 29526.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1795 5130.25 189680.50 36.97
TCON-TCON-TRANSITION CONFERENCE 200 200.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1913 8097.75 253431.50 31.30
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 55 93.50 4675.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 55 87.50 6562.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 8.50 637.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 19 23.50 1762.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 26 46.50 3487.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 35.00 1942.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 12 12.00 666.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 261 407.50 30562.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 53 93.50 7012.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 111 152.50 11437.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 170 273.00 15151.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 57 81.00 6075.00 75.00
Subtotal (Total Children Is Unduplicated) 458 1314.00 89972.50 68.47
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 631.90 631.90
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 76 95.75 4787.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 1.00 25.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 15.00 750.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 29.00 1450.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 2 0.75 18.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 18.25 912.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 66.50 3325.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 90 397.50 19875.00 50.00
INTR-INTR-INTERPRETER 11 15.00 750.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 30 151.00 9748.24 64.56
PHY-97110-PT SESSION BY LICENSED PT 27 143.00 9421.84 65.89
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 94.75 6431.63 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 232 27753.0 13876.50 0.50
Subtotal (Total Children Is Unduplicated) 259 28781.5 72003.86 2.50
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Total 38193.25 415407.86 10.88
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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 107 70.50 2691.00 0.00
U 0 0.00 0.00 0.00
B 2956 2471.75 113518.41 46.25
P 6716 21890.25 168229.79 251568.15
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 3402 11633.00 79114.65 79114.65
1156 2127.75 51854.01 0.00
Other 0 0.00 0.00 0.00
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Total 14337 38193.25 415407.86 330729.05