CMS/EIP Fiscal Report Center: 06
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 426 249.50 9231.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 634 663.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 433 387.25 14328.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1610 5250.25 194259.25 37.00
TCON-TCON-TRANSITION CONFERENCE 197 197.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1619 6747.00 217819.00 32.28
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 125 125.00 1103.75 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 125 125.00 1350.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 121 121.00 2636.59 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 9 9.00 254.52 28.28
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 15.50 1162.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 16.00 1200.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 270 408.50 30637.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 249 375.00 28125.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 63.00 4725.00 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 5 5.00 136.10 27.22
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 24 24.00 1374.48 57.27
Subtotal (Total Children Is Unduplicated) 356 1288.50 72817.94 56.51
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.25 112.50 50.00
INTR-INTR-INTERPRETER 1 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 2.00 135.76 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 5 38.75 511.50 13.20
Subtotal (Total Children Is Unduplicated) 9 45.00 859.76 19.11
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Total 8080.50 291496.70 36.07
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Number of Children (Unduplicated) With at Least One Service 1625
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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 1434 1046.25 38711.25 582.75
P 1376 1065.50 46985.50 46948.00
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
7955 5968.75 205799.95 795.50
Other 0 0.00 0.00 0.00
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Total 10765 8080.50 291496.70 48326.25