CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 268 124.75 4615.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 455 569.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 138 161.00 5957.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 899 2352.00 87024.00 37.00
TCON-TCON-TRANSITION CONFERENCE 136 136.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 953 3342.75 97596.75 29.20
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 58 59.00 520.97 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 26 26.00 280.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 59 59.00 1285.61 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.00 113.12 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.50 637.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.50 360.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 62 110.00 8250.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 13.00 975.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 60 106.00 5883.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 133 133.00 6650.00 50.00
Subtotal (Total Children Is Unduplicated) 204 536.00 25418.76 47.42
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 9.00 450.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 3.00 75.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 5.50 275.00 50.00
Subtotal (Total Children Is Unduplicated) 6 17.50 800.00 45.71
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Total 3896.25 123815.51 31.78
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Number of Children (Unduplicated) With at Least One Service 966
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Center 03
Flag Claims Units Chgs Paid
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R 6 3.50 129.50 0.00
U 0 0.00 0.00 0.00
B 454 369.50 15599.25 9.25
P 854 703.50 26620.50 26620.50
D 0 0.00 0.00 0.00
S 1 0.50 18.50 0.00
H 1 0.25 9.25 9.25
T 3102 2491.50 72871.03 72852.53
237 194.00 6577.75 0.00
Other 134 133.50 1989.73 18.50
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Total 4789 3896.25 123815.51 99510.03