CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
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
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 125 134.50 4976.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 230 971.50 35945.50 37.00
Subtotal (Total Children Is Unduplicated) 230 1107.00 40922.00 36.97
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.38 10.38
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.50 262.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 102 164.00 12300.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 85.00 6375.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 44 63.50 4762.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 121 223.00 12376.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 62 82.50 6187.50 75.00
Subtotal (Total Children Is Unduplicated) 165 632.50 42754.90 67.60
----------------------------------------------------------------------------------------------------------------
Total 1739.50 83676.90 48.10
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 231
----------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 8 3.75 138.75 0.00
U 0 0.00 0.00 0.00
B 404 372.75 14842.50 74.00
P 255 324.25 18844.40 18844.40
D 0 0.00 0.00 0.00
S 39 41.00 1914.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
896 997.75 47936.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1602 1739.50 83676.90 18918.40