CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Eligibility Filter:DEI Only
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 12 6.25 231.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 22 23.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 27 26.00 962.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 83 227.25 8408.25 37.00
Subtotal (Total Children Is Unduplicated) 85 282.50 9601.50 33.99
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.00 8.83 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.00 10.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.00 21.79 21.79
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.00 300.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.50 337.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 7 19.00 1159.17 61.01
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.75 37.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 39.00 1950.00 50.00
INTR-INTR-INTERPRETER 2 8.00 468.00 58.50
OCCT-97530-OT SESSION BY LICENSED OT 2 8.00 543.04 67.88
PHY-97110-PT SESSION BY LICENSED PT 3 4.00 271.52 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 7.00 475.16 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 1624.00 812.00 0.50
Subtotal (Total Children Is Unduplicated) 10 1690.75 4557.22 2.70
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Total 1992.25 15317.89 7.69
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Number of Children (Unduplicated) With at Least One Service 85
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Center 06
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 85 53.75 1988.75 101.75
P 226 644.25 5286.57 5286.57
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 0 0.00 0.00 0.00
272 1294.25 8042.57 55.50
Other 0 0.00 0.00 0.00
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Total 583 1992.25 15317.89 5443.82