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
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 14 22.50 1687.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 25.00 1875.00 75.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.00 57.27 57.27
Subtotal (Total Children Is Unduplicated) 20 83.50 4112.50 49.25
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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 4603.50 136199.50 29.59
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Number of Children (Unduplicated) With at Least One Service 1382
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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 0 0.00 0.00 0.00
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
6742 4603.50 136199.50 499.50
Other 0 0.00 0.00 0.00
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Total 6742 4603.50 136199.50 499.50