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: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 435 241.50 8935.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 690 730.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 444 400.75 14827.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 890 2927.50 108317.50 37.00
TCON-TCON-TRANSITION CONFERENCE 218 220.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1382 4519.75 132080.75 29.22
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 12 12.00 105.96 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 11 11.00 118.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 11 11.00 239.69 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 26.50 1987.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 25.00 1875.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
Subtotal (Total Children Is Unduplicated) 22 91.50 4634.50 50.65
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 192.74 96.37
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 4.50 205.00 45.56
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.00 100.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 33.50 437.50 13.06
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 7.75 387.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 3.50 175.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 6 38.50 1925.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 135 999.25 49962.50 50.00
INTR-INTR-INTERPRETER 10 34.00 1932.00 56.82
OCCT-97530-OT SESSION BY LICENSED OT 60 217.00 12498.62 57.60
OCCT-97530HM-OT SESSION BY OT ASST 4 10.00 457.44 45.74
PHY-97110-PT SESSION BY LICENSED PT 109 419.25 26917.51 64.20
PHY-97110HM-PT SESSION BY PT ASST 2 1.75 37.39 21.37
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 437 2240.50 142087.99 63.42
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.50 -17.20 0.00
TRAN-TRAN-FAMILY TRANSPORTATION 1 1.00 40.00 40.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 765 144155 72335.25 0.50
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 30.00 15.00 0.50
Subtotal (Total Children Is Unduplicated) 879 148202 309695.49 2.09
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Total 152813.50 446410.74 2.92
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Number of Children (Unduplicated) With at Least One Service 1519
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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 5294 64990.25 135381.59 135381.59
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 1 0.75 50.91 0.00
T 0 0.00 0.00 0.00
13266 87822.50 310978.24 2983.40
Other 0 0.00 0.00 0.00
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Total 18561 152813.50 446410.74 138364.99