CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Eligibility Filter:Not Part C
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 65 30.75 1137.75 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 10.75 397.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 165 411.25 15216.25 37.00
Subtotal (Total Children Is Unduplicated) 166 452.75 16751.75 37.00
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.00 26.49 8.83
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.00 65.37 21.79
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 225.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.00 222.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 39.00 2925.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 16.00 1200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 90.00 4995.00 55.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 81 95.00 4750.00 50.00
Subtotal (Total Children Is Unduplicated) 123 254.00 14483.86 57.02
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Total 706.75 31235.61 44.20
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Number of Children (Unduplicated) With at Least One Service 168
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Center 03
Flag Claims Units Chgs Paid
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R 1 0.75 27.75 0.00
U 0 0.00 0.00 0.00
B 21 32.75 1211.75 0.00
P 260 264.50 11378.00 11328.00
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 242 225.00 10273.00 10273.00
193 177.75 8253.25 0.00
Other 6 6.00 91.86 0.00
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Total 723 706.75 31235.61 21601.00