CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 445 196.00 7252.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 511 634.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 191 185.25 6854.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 996 2759.50 102101.50 37.00
TCON-TCON-TRANSITION CONFERENCE 159 161.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1043 3935.75 116207.75 29.53
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 6 6.00 97.80 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 81 81.00 715.23 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 30 30.00 324.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 78 78.00 1699.62 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 10.00 750.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 15.50 860.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 73 130.00 9750.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 53.50 4012.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 109 199.50 11072.25 55.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 111 111.00 5550.00 50.00
Subtotal (Total Children Is Unduplicated) 243 718.50 34948.30 48.64
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 3.50 175.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 3.00 75.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 26.00 1300.00 50.00
Subtotal (Total Children Is Unduplicated) 7 32.50 1550.00 47.69
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Total 4686.75 152706.05 32.58
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Number of Children (Unduplicated) With at Least One Service 1047
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Center 03
Flag Claims Units Chgs Paid
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R 4 2.50 120.25 0.00
U 0 0.00 0.00 0.00
B 565 388.25 15142.25 0.00
P 1154 867.75 33785.50 33785.50
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 2593 2029.25 61907.35 61907.35
1752 1227.50 39178.00 0.00
Other 172 171.50 2572.70 0.00
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Total 6240 4686.75 152706.05 95692.85