CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
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 20 49.50 1831.50 37.00
Subtotal (Total Children Is Unduplicated) 50 104.75 3024.75 28.88
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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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
Subtotal (Total Children Is Unduplicated) 2 7.50 378.92 50.52
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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 4 31.00 1550.00 50.00
INTR-INTR-INTERPRETER 2 8.00 468.00 58.50
PHY-97110-PT SESSION BY LICENSED PT 1 1.50 101.82 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 1672.25 3444.48 2.06
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Total 1784.50 6848.15 3.84
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Number of Children (Unduplicated) With at Least One Service 53
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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 0 0.00 0.00 0.00
P 31 520.50 707.82 707.82
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
240 1264.00 6140.33 55.50
Other 0 0.00 0.00 0.00
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Total 271 1784.50 6848.15 763.32