CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 1041 480.50 17760.25 36.96
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 700 722.75 26741.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2426 7285.25 269165.75 36.95
Subtotal (Total Children Is Unduplicated) 2466 8488.50 313667.75 36.95
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.00 194.00 48.50
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 2.00 17.66 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 5.00 61.92 12.38
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.00 68.62 22.87
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 2.00 58.91 29.46
EXIT-EXIT-TRANSITION ASSESSMENT 138 286.50 14325.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 43 63.50 4762.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 31 50.00 3750.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 29.00 1609.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 268 392.50 29400.00 74.90
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 46.00 3450.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 64 85.00 6375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 216 312.50 17343.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 119 177.50 13312.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.00 97.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 15.00 699.21 46.61
SPCH-92506-SPEECH EVAL BY LICENSED SLP 27 27.00 1386.37 51.35
Subtotal (Total Children Is Unduplicated) 574 1523.50 98087.26 64.38
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 15 67.00 20261.03 302.40
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 102 136.00 6800.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 5 2.00 50.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 18 19.75 987.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 12 5.50 137.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 4.00 200.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 5.25 262.50 50.00
CONPP-CONPP-CONSULT, PT, PHONE 3 1.25 31.25 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 28.00 1400.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 8 7.25 181.25 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 39 270.50 7722.50 28.55
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 43 345.25 17262.50 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 38.25 1912.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 733 5216.00 258445.00 49.55
INTR-INTR-INTERPRETER 101 466.50 14695.28 31.50
OCCT-97530-OT SESSION BY LICENSED OT 63 387.00 27699.73 71.58
OCCT-97530HM-OT SESSION BY OT ASST 1 3.00 162.96 54.32
PHY-97110-PT SESSION BY LICENSED PT 198 1286.25 90101.19 70.05
PHY-97110HM-PT SESSION BY PT ASST 2 3.00 162.96 54.32
RSPT-RSPT-RESPITE 1 78.00 624.00 8.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 13 69.00 3450.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 403 2809.00 192745.07 68.62
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 7.00 380.24 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 3 6.00 79.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1208 296924 148459.50 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 6 42.25 2112.50 50.00
Subtotal (Total Children Is Unduplicated) 1356 308228 796376.16 2.58
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Total 318240.00 1208131.17 3.80
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Number of Children (Unduplicated) With at Least One Service 2539
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Center 01
Flag Claims Units Chgs Paid
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R 16 8.25 374.13 0.00
U 0 0.00 0.00 0.00
B 4688 3219.75 127395.00 9.25
P 5230 84239.50 162278.30 161217.96
D 200 219.75 11839.63 0.00
S 862 672.75 28906.75 0.00
H 4385 99973.25 139293.45 138268.45
T 4911 102315.00 197087.67 197087.67
8416 9499.00 348330.82 1337.58
Other 3065 18092.75 192625.42 132.07
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Total 31773 318240.00 1208131.17 498052.98