CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EIP DEI DEIP
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 1709 5740.25 212389.25 37.00
TCON-TCON-TRANSITION CONFERENCE 218 220.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1724 7332.50 236152.50 32.21
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 125 125.00 1103.75 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 125 125.00 1350.00 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 122 122.00 2658.38 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.00 141.40 28.28
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.00 450.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.00 375.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 1.00 75.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 231 326.50 24487.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 191 286.50 21487.50 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 15.50 1162.50 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 3 3.00 81.66 27.22
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 12 12.00 687.24 57.27
Subtotal (Total Children Is Unduplicated) 304 1032.50 54059.93 52.36
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EI Services,Class #03
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
Subtotal (Total Children Is Unduplicated) 1 0.25 6.25 25.00
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Total 8365.25 290218.68 34.69
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Number of Children (Unduplicated) With at Least One Service 1724
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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 1538 961.25 35566.25 129.50
P 2688 1758.25 65055.25 65055.25
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
7663 5645.75 189597.18 499.50
Other 0 0.00 0.00 0.00
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Total 11889 8365.25 290218.68 65684.25