CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 798 481.00 17797.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 606 782.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 202 219.50 8121.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1050 3181.25 117706.25 37.00
TCON-TCON-TRANSITION CONFERENCE 122 123.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1124 4786.75 143624.75 30.00
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 4 4.00 65.20 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 60 60.00 529.80 8.83
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.00 27.10 27.10
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 22 22.00 237.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 58 58.00 1263.82 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
EXIT-EXIT-TRANSITION ASSESSMENT 69 108.50 5425.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.50 412.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.50 749.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 75 124.50 9337.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 43.00 3225.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 180 334.50 18564.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 64 79.00 3950.00 50.00
Subtotal (Total Children Is Unduplicated) 314 862.50 44374.56 51.45
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 25.75 1287.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 4.00 200.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 101.75 5087.50 50.00
Subtotal (Total Children Is Unduplicated) 32 131.50 6575.00 50.00
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Total 5780.75 194574.31 33.66
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Number of Children (Unduplicated) With at Least One Service 1130
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Center 03
Flag Claims Units Chgs Paid
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R 10 12.50 538.50 0.00
U 0 0.00 0.00 0.00
B 222 173.50 6561.25 64.75
P 2349 1753.50 70294.75 70113.50
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 3305 2292.75 69714.23 69714.23
1997 1409.50 45336.75 0.00
Other 139 139.00 2128.83 0.00
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Total 8022 5780.75 194574.31 139892.48