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
Payclass Filters:GR
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 501 1471.50 54445.50 37.00
TCON-TCON-TRANSITION CONFERENCE 122 123.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1021 3077.00 80364.00 26.12
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.00 35.32 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.00 32.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.00 108.95 21.79
EXIT-EXIT-TRANSITION ASSESSMENT 69 108.50 5425.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.50 262.50 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 4 7.50 416.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 36 61.50 4612.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 30.00 2250.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 106 204.00 11322.00 55.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 51 52.00 2600.00 50.00
Subtotal (Total Children Is Unduplicated) 211 482.00 27231.22 56.50
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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 11 41.25 2062.50 50.00
Subtotal (Total Children Is Unduplicated) 23 71.00 3550.00 50.00
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Total 3630.00 111145.22 30.62
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Number of Children (Unduplicated) With at Least One Service 1031
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Center 03
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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
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 3305 2292.75 69714.23 69714.23
1946 1333.25 41369.75 0.00
Other 4 4.00 61.24 0.00
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Total 5255 3630.00 111145.22 69714.23