CMS/EIP Fiscal Report Center: 53
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 92 35.00 1295.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 242 249.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 261 217.75 8056.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 172 310.00 11470.00 37.00
TCON-TCON-TRANSITION CONFERENCE 24 25.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 389 836.75 20821.75 24.88
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.00 17.66 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 3.00 32.40 10.80
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.00 16.88 8.44
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 3.00 65.37 21.79
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.00 63.62 31.81
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 6 6.00 650.00 108.33
EXIT-EXIT-TRANSITION ASSESSMENT 56 108.00 5400.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 5.50 305.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.50 249.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 68 128.24 7117.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.00 750.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 14.95 1121.60 75.02
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.00 1200.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 36.58 2030.60 55.51
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 31.51 2363.60 75.01
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.50 75.00 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 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 8 8.00 388.00 48.50
Subtotal (Total Children Is Unduplicated) 161 396.28 22549.85 56.90
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.00 55.00 55.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 95 138.75 6937.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 20 15.00 375.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 14 13.00 650.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.00 250.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 10.00 500.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 2 1.50 37.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 6.00 300.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 14.00 350.00 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 30 188.00 9400.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 10.00 500.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 89 549.00 27450.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 3.00 150.00 50.00
INTR-INTR-INTERPRETER 8 20.00 1000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 16 52.63 3572.44 67.88
PHY-97110-PT SESSION BY LICENSED PT 17 98.32 6675.09 67.89
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 176.00 11946.88 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 521 88088.0 44044.00 0.50
Subtotal (Total Children Is Unduplicated) 533 89391.2 114268.41 1.28
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Total 90624.23 157640.01 1.74
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Number of Children (Unduplicated) With at Least One Service 589
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Center 53
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 636 18474.40 27175.99 27157.24
T 642 19767.00 28341.23 28341.23
3070 52382.83 102122.79 0.00
Other 0 0.00 0.00 0.00
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Total 4348 90624.23 157640.01 55498.47