CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
Eligibility Filter:Program Patients
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 863 511.75 18934.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 606 782.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 210 230.25 8519.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 580 1648.75 61003.75 37.00
TCON-TCON-TRANSITION CONFERENCE 122 123.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1135 3295.75 88457.75 26.84
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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 4 6.50 487.50 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 6 10.50 582.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 51 83.00 6225.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 52.50 3937.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.00 1095.00 68.44
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 141 264.50 14679.75 55.50
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 10 10.00 485.00 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 10 10.00 460.75 46.08
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 13.00 585.63 45.05
SCREEN-T1023-INTERDISCIPLINARY SCREENING 108 123.00 6150.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 46 47.00 2235.98 47.57
Subtotal (Total Children Is Unduplicated) 362 766.50 43032.33 56.14
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 7.00 427.57 61.08
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 173 205.00 10243.75 49.97
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 92 118.50 5925.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 25 18.50 462.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 50.25 2512.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 15 9.50 237.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 33 50.25 2555.00 50.85
CONPP-CONPP-CONSULT, PT, PHONE 5 1.50 37.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 84 113.75 5757.50 50.62
CONSP-CONSP-CONSULT, SLP, PHONE 15 10.25 256.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 205 1473.50 70573.88 47.90
INTR-INTR-INTERPRETER 14 197.25 10291.25 52.17
OCCT-97530-OT SESSION BY LICENSED OT 75 498.25 28896.41 58.00
PHY-97110-PT SESSION BY LICENSED PT 83 566.75 33505.60 59.12
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 157 1090.75 63124.70 57.87
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 500 110202 54838.59 0.50
Subtotal (Total Children Is Unduplicated) 583 114613 289645.50 2.53
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Total 118675.25 421135.58 3.55
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Number of Children (Unduplicated) With at Least One Service 1212
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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 5194 75700.75 196761.72 196775.47
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 3547 2517.75 79987.23 79987.23
4784 40452.75 144325.39 0.00
Other 4 4.00 61.24 0.00
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Total 13529 118675.25 421135.58 276762.70