CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:TPIN
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 1 0.25 9.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.25 9.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 8 12.50 462.50 37.00
Subtotal (Total Children Is Unduplicated) 8 13.00 481.00 37.00
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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) 2 3.00 26.05 8.68
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 3.00 32.40 10.80
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.50 187.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.00 291.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.00 15.00 15.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.00 485.00 48.50
Subtotal (Total Children Is Unduplicated) 25 37.50 1671.91 44.58
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 54.00 54.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 102.00 5100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 24 122.50 8349.24 68.16
PHY-97110-PT SESSION BY LICENSED PT 8 42.25 2867.93 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 2.00 108.64 54.32
SENS-V5264-EARMOLD 3 8.00 148.32 18.54
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 48 263.25 17601.59 66.86
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9 1260.00 630.00 0.50
Subtotal (Total Children Is Unduplicated) 86 1801.00 34859.72 19.36
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Total 1851.50 37012.63 19.99
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Number of Children (Unduplicated) With at Least One Service 106
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Center 07
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 51 197.00 11662.70 11662.70
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
182 1654.50 25349.93 0.00
Other 0 0.00 0.00 0.00
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Total 233 1851.50 37012.63 11662.70