CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Payclass Filters:GR
Eligibility Filter:Not Part C
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 4 4.00 148.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 51 52.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 489 540.75 20007.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 419 2304.00 85248.00 37.00
Subtotal (Total Children Is Unduplicated) 620 2900.75 105403.75 36.34
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 9 10.00 106.91 10.69
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 9 10.00 87.40 8.74
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 10.00 104.64 10.46
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 10.00 213.11 21.31
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 10 11.00 287.64 26.15
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 15.00 1125.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.50 749.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 101 167.50 12562.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 59 93.00 6975.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 63 82.50 6187.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 129 224.50 12459.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 54.50 4087.50 75.00
Subtotal (Total Children Is Unduplicated) 198 705.50 45246.20 64.13
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Total 3606.25 150649.95 41.77
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Number of Children (Unduplicated) With at Least One Service 637
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Center 10
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 51 51.00 799.70 799.70
D 28 26.50 1226.50 1180.25
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
3344 3528.75 148623.75 0.00
Other 0 0.00 0.00 0.00
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Total 3423 3606.25 150649.95 1979.95