CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
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 1111 907.00 33559.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 210 219.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 601 858.00 31709.50 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 1570 5284.25 195480.25 36.99
TCON-TCON-TRANSITION CONFERENCE 39 39.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1618 7307.25 260748.75 35.68
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 47.00 47.00
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 24.66 12.33
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 6.00 52.10 8.68
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 7.00 75.60 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.00 43.58 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 107.66 53.83
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.00 28.28 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.00 31.52 31.52
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 0.75 37.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 36 68.00 3400.00 50.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 22.00 1650.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.00 444.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 53 98.00 7282.50 74.31
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 17.50 1312.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 15.00 1125.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 111 211.50 11738.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 171 499.00 37425.00 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.00 145.56 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 5 5.25 262.50 50.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.00 194.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 26 27.00 1201.04 44.48
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.00 48.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 13.00 630.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 37 37.00 1850.00 50.00
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.00 15.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 73 74.00 3589.00 48.50
Subtotal (Total Children Is Unduplicated) 391 1128.50 72890.05 64.59
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 5.00 654.00 130.80
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 25.50 1275.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 10 9.00 450.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 9 4.50 112.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 26.50 1325.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 19 21.50 1075.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 32.75 1637.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.25 56.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 578 4159.00 207950.00 50.00
INTR-INTR-INTERPRETER 2 6.00 300.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 116 768.25 50062.29 65.16
OCCT-97530HM-OT SESSION BY OT ASST 2 4.00 217.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 96 555.25 35996.43 64.83
PHY-97110HM-PT SESSION BY PT ASST 1 2.00 108.64 54.32
SENS-V5264-EARMOLD 6 13.00 240.48 18.50
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 337 2343.00 154316.69 65.86
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 645 128950 64442.50 0.50
Subtotal (Total Children Is Unduplicated) 979 136929 520269.56 3.80
----------------------------------------------------------------------------------------------------------------
Total 145364.25 853908.36 5.87
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1684
----------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 87 49.00 1870.00 0.00
P 8095 131503.50 454124.50 454012.00
D 14 6.75 249.75 0.00
S 111 54.25 1998.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
10101 13748.75 395592.11 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 18411 145364.25 853908.36 454012.00