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
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 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 538 1638.50 60624.50 37.00
TCON-TCON-TRANSITION CONFERENCE 164 164.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 949 3283.75 86718.75 26.41
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.00 35.32 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.00 32.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.00 87.16 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
EXIT-EXIT-TRANSITION ASSESSMENT 17 30.50 1525.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 11.50 638.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 61 105.50 7912.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 31.50 2362.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 118 216.50 12015.75 55.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 74 74.00 3700.00 50.00
Subtotal (Total Children Is Unduplicated) 185 486.50 28691.54 58.98
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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 2 3.00 150.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 6.00 300.00 50.00
Subtotal (Total Children Is Unduplicated) 16 32.00 1600.00 50.00
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Total 3802.25 117010.29 30.77
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Number of Children (Unduplicated) With at Least One Service 954
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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 1 0.25 9.25 9.25
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
1940 1331.75 41524.00 0.00
Other 4 4.00 113.28 0.00
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Total 5348 3802.25 117010.29 75373.01