CMS/EIP Fiscal Report Center: 06
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 528 287.50 10637.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 603 636.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 389 359.00 13283.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1572 4746.75 175657.50 37.01
TCON-TCON-TRANSITION CONFERENCE 219 226.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1584 6255.25 199578.00 31.91
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 106 107.00 944.81 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 104 105.00 1134.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 104 105.00 2287.95 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 20.50 1537.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 20.00 1500.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 212 336.00 25200.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 200 306.50 22987.50 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 21.00 1575.00 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 5 5.00 136.10 27.22
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 22 22.00 1259.94 57.27
MED-99212-OUTPATIENT VISIT, EST, 10 MINS 1 1.00 18.17 18.17
Subtotal (Total Children Is Unduplicated) 272 1052.00 58665.81 55.77
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.00 200.00 50.00
Subtotal (Total Children Is Unduplicated) 1 4.00 200.00 50.00
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Total 7311.25 258443.81 35.35
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Number of Children (Unduplicated) With at Least One Service 1588
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Center 06
Flag Claims Units Chgs Paid
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R 8 4.00 148.00 111.00
U 0 0.00 0.00 0.00
B 1807 1251.00 46287.00 0.00
P 747 487.75 18046.75 18046.75
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 1 0.25 9.25 0.00
7601 5568.25 193952.81 148.00
Other 0 0.00 0.00 0.00
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Total 10164 7311.25 258443.81 18305.75