CMS/EIP Fiscal Report Center: 03
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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 698 422.25 15623.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 544 776.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 262 283.00 10471.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1007 3118.75 115393.75 37.00
TCON-TCON-TRANSITION CONFERENCE 164 164.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1038 4764.00 141488.00 29.70
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 71 71.00 626.93 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 26 26.00 280.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 70 70.00 1525.30 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 4 4.00 217.52 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.00 226.24 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.81 31.81
EXIT-EXIT-TRANSITION ASSESSMENT 17 30.50 1525.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.50 412.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 13.00 721.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 85 144.00 10800.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 54.00 4050.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 156 280.50 15567.75 55.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 97 97.00 4850.00 50.00
Subtotal (Total Children Is Unduplicated) 272 809.50 40911.17 50.54
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 23.00 1150.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 42.50 2125.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 6.00 300.00 50.00
Subtotal (Total Children Is Unduplicated) 23 71.50 3575.00 50.00
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Total 5645.00 185974.17 32.94
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Number of Children (Unduplicated) With at Least One Service 1043
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Center 03
Flag Claims Units Chgs Paid
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R 3 0.75 27.75 0.00
U 0 0.00 0.00 0.00
B 70 42.50 1626.25 0.00
P 1920 1411.00 56552.50 63687.00
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 3403 2466.25 75363.76 75363.76
2239 1544.50 49395.75 0.00
Other 179 180.00 3008.16 27.75
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Total 7814 5645.00 185974.17 139078.51