CMS/EIP Fiscal Report Center: 06
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 478 264.75 9795.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 602 637.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 349 343.00 12691.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1523 3929.75 145363.25 36.99
TCON-TCON-TRANSITION CONFERENCE 176 190.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1539 5364.50 167850.00 31.29
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 90 90.00 794.70 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 87 87.00 939.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 86 86.00 1873.94 21.79
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 12.00 900.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.00 450.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.00 450.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 197 310.00 23250.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 140 218.00 16350.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 93 154.00 11550.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.00 1050.00 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 6 6.00 163.32 27.22
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 20 20.00 1145.40 57.27
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 2 2.00 36.34 18.17
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 8 8.00 276.00 34.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 252 1023.00 59423.30 58.09
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 1 2.00 100.00 50.00
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Total 6389.50 227373.30 35.59
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Number of Children (Unduplicated) With at Least One Service 1541
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Center 06
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 2191 1436.25 53119.50 83.25
P 1812 1203.25 35999.84 35999.84
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 0 0.00 0.00 0.00
4700 3750.00 138253.96 0.00
Other 0 0.00 0.00 0.00
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Total 8703 6389.50 227373.30 36083.09