CMS/EIP Fiscal Report Center: 06
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 445 275.50 10193.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 634 686.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 550 512.50 18962.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1705 5931.50 219419.25 36.99
TCON-TCON-TRANSITION CONFERENCE 171 172.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1709 7577.50 248575.25 32.80
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 117 117.00 1033.11 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 118 118.00 1274.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 111 111.00 2418.69 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.50 487.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 10.50 787.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.00 300.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 155 216.00 16200.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 185 281.50 21112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 15.00 832.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 45.00 3375.00 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 6 6.00 163.32 27.22
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 23 23.00 1317.21 57.27
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 194.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.00 436.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 291 977.00 50413.04 51.60
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 6.00 969.26 161.54
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 9.00 375.00 41.67
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 3.75 187.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 5.25 227.50 43.33
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 4.00 200.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.00 150.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 9 43.75 2175.00 49.71
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 4.00 200.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 289 2008.75 100437.50 50.00
INTR-INTR-INTERPRETER 40 149.00 8341.50 55.98
OCCT-97530-OT SESSION BY LICENSED OT 125 564.50 35716.78 63.27
OCCT-97530HM-OT SESSION BY OT ASST 9 31.00 1598.16 51.55
PHY-97110-PT SESSION BY LICENSED PT 193 1038.50 66186.90 63.73
PHY-97110HM-PT SESSION BY PT ASST 2 10.50 570.36 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 591 3703.50 238650.35 64.44
SPL-92508-GROUP SPL SESSION PER CHILD 28 492.00 6494.40 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 3 60.00 109.00 1.82
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 764 144698 72740.75 0.50
Subtotal (Total Children Is Unduplicated) 930 152836 535367.46 3.50
----------------------------------------------------------------------------------------------------------------
Total 161390.50 834355.75 5.17
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1755
----------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 3832 2513.25 92990.25 18.50
P 697 2758.75 17790.49 17857.23
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
24508 156118.50 723575.01 212.75
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 29037 161390.50 834355.75 18088.48