CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
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 787 395.00 14615.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 710 832.25 30774.75 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 2092 6205.25 229298.25 36.95
Subtotal (Total Children Is Unduplicated) 2125 7432.50 274688.00 36.96
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 12.00 558.50 46.54
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.28 8.28
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 27.19 27.19
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.00 93.60 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.00 119.60 119.60
EXIT-EXIT-TRANSITION ASSESSMENT 102 201.00 10050.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 34 49.50 3712.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.50 337.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.50 562.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 40 82.00 6112.50 74.54
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 16.00 888.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 238 321.50 24075.00 74.88
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 58.00 4350.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 56.50 4237.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 245 341.50 18897.75 55.34
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 129 184.50 13808.25 74.84
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 2.00 145.56 72.78
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.00 339.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 7.00 339.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 24 32.00 1552.00 48.50
Subtotal (Total Children Is Unduplicated) 530 1396.50 90586.90 64.87
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 14 70.00 12688.61 181.27
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 61 89.75 4487.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 8 5.25 131.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 10 8.00 400.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 8 4.25 106.25 25.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.50 175.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 2.25 56.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 22 39.50 1975.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 5 2.75 68.75 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 34 263.75 7173.75 27.20
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 31 224.50 11225.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 31 266.00 13300.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 658 4691.00 234503.33 49.99
INTR-INTR-INTERPRETER 83 396.00 14649.22 36.99
OCCT-97530-OT SESSION BY LICENSED OT 56 271.75 18595.86 68.43
OCCT-97530HM-OT SESSION BY OT ASST 2 3.00 176.52 58.84
PHY-97110-PT SESSION BY LICENSED PT 175 1174.00 79703.94 67.89
PHY-97110HM-PT SESSION BY PT ASST 3 14.00 760.48 54.32
RSPT-RSPT-RESPITE 1 89.50 716.00 8.00
SENS-V5014-HEARING AID REPAIR BY MANUFACTURER 1 1.00 114.00 114.00
SENS-V5264-EARMOLD 1 2.00 37.44 18.72
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 4 32.00 1600.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 409 2473.75 167792.36 67.83
SPL-92508-GROUP SPL SESSION PER CHILD 8 29.00 382.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1135 271122 136067.50 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 8 52.00 2600.00 50.00
Subtotal (Total Children Is Unduplicated) 1284 281331 709499.31 2.52
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Total 290160.00 1074774.21 3.70
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Number of Children (Unduplicated) With at Least One Service 2288
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Center 01
Flag Claims Units Chgs Paid
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R 17 12.00 444.00 0.00
U 0 0.00 0.00 0.00
B 1584 1009.75 39316.50 277.50
P 8613 157897.36 323354.22 322387.19
D 244 237.75 12422.00 0.00
S 803 602.75 22399.50 0.00
H 11 18.50 1220.56 0.00
T 3410 87957.75 161644.74 162351.57
7553 9421.14 317325.10 507.28
Other 3279 33003.00 196647.59 312.50
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Total 25514 290160.00 1074774.21 485836.04