CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 751 454.00 16798.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 623 792.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 172 186.00 6882.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1058 3115.25 115264.25 37.00
TCON-TCON-TRANSITION CONFERENCE 142 142.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1115 4689.25 138944.25 29.63
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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 3 3.00 48.90 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 55 55.00 485.65 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 21 21.00 226.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 52 52.00 1133.08 21.79
AUDE-92586-AUD EVOKED RESPONSE (SCREEN) 2 2.00 60.86 30.43
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.00 169.68 28.28
EXIT-EXIT-TRANSITION ASSESSMENT 67 105.50 5275.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 8.50 637.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 15.50 860.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 76 121.00 9075.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 42.00 3150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 170 304.50 16899.75 55.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 12 12.00 600.00 50.00
Subtotal (Total Children Is Unduplicated) 287 749.00 38633.09 51.58
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 9.00 450.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 3.25 162.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 43.00 2150.00 50.00
Subtotal (Total Children Is Unduplicated) 17 56.25 2812.50 50.00
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Total 5494.50 180389.84 32.83
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Number of Children (Unduplicated) With at Least One Service 1120
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Center 03
Flag Claims Units Chgs Paid
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R 47 41.00 1722.50 0.00
U 0 0.00 0.00 0.00
B 62 46.75 1824.25 0.00
P 2227 1580.75 62905.25 62877.50
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 3729 2522.00 75441.09 75441.09
1769 1173.00 36500.75 0.00
Other 131 131.00 1996.00 0.00
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Total 7965 5494.50 180389.84 138318.59