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
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 523 286.00 10582.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 599 632.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 389 359.00 13283.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 951 2706.00 100122.00 37.00
TCON-TCON-TRANSITION CONFERENCE 219 226.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1344 4209.00 123987.00 29.46
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 9 9.00 79.47 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 8.00 86.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 8.00 174.32 21.79
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 33.00 2475.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 27.50 2062.50 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.00 375.00 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.00 114.54 57.27
Subtotal (Total Children Is Unduplicated) 24 94.50 5421.67 57.37
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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 4307.50 129608.67 30.09
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Number of Children (Unduplicated) With at Least One Service 1345
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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 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 0 0.00 0.00 0.00
6375 4307.50 129608.67 148.00
Other 0 0.00 0.00 0.00
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Total 6375 4307.50 129608.67 148.00