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
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 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 571 1502.00 55574.00 37.00
TCON-TCON-TRANSITION CONFERENCE 159 161.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 911 2678.25 69680.25 26.02
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.00 32.60 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 11 11.00 97.13 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.00 75.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 9.00 196.11 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
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 56 99.50 7462.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 35.00 2625.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 91 166.50 9240.75 55.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 83 83.00 4150.00 50.00
Subtotal (Total Children Is Unduplicated) 168 439.50 25518.22 58.06
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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 1 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 4 8.50 350.00 41.18
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Total 3126.25 95548.47 30.56
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Number of Children (Unduplicated) With at Least One Service 917
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Center 03
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 0 0.00 0.00 0.00
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
1584 1095.00 33610.50 0.00
Other 2 2.00 30.62 0.00
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Total 4179 3126.25 95548.47 61907.35