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
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 478 264.25 9777.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 601 636.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 348 341.75 12644.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 918 2346.25 86795.50 36.99
TCON-TCON-TRANSITION CONFERENCE 176 190.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1295 3778.25 109217.50 28.91
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 12 12.00 105.96 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 12 12.00 129.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 12.00 261.48 21.79
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 22.50 1687.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 16.00 1200.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 11.50 862.50 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 3 3.00 103.50 34.50
Subtotal (Total Children Is Unduplicated) 23 92.00 4575.54 49.73
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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 3872.25 113893.04 29.41
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Number of Children (Unduplicated) With at Least One Service 1295
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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 0 0.00 0.00 0.00
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
3802 2669.00 77893.20 0.00
Other 0 0.00 0.00 0.00
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Total 5614 3872.25 113893.04 35999.84