CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Agency Filter:EIP DEI DEIP
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
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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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.00 375.00 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 149 206.00 15450.00 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 3 5.00 277.50 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
Subtotal (Total Children Is Unduplicated) 270 934.00 47940.79 51.33
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EI Services,Class #03
CONOP-CONOP-CONSULT, OT, PHONE 1 0.50 12.50 25.00
INTR-INTR-INTERPRETER 6 12.00 724.00 60.33
SPL-92508-GROUP SPL SESSION PER CHILD 5 46.50 613.80 13.20
Subtotal (Total Children Is Unduplicated) 12 59.00 1350.30 22.89
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Total 8570.50 297866.34 34.75
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Number of Children (Unduplicated) With at Least One Service 1710
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Center 06
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 3832 2513.25 92990.25 18.50
P 451 291.25 10776.25 10776.25
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
7973 5766.00 194099.84 212.75
Other 0 0.00 0.00 0.00
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Total 12256 8570.50 297866.34 11007.50