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
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 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 891 3014.25 111481.00 36.98
TCON-TCON-TRANSITION CONFERENCE 171 172.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1396 4660.25 140637.00 30.18
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 16 16.00 141.28 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 16 16.00 172.80 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 16 16.00 348.64 21.79
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 13.00 975.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 22.50 1687.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.50 194.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.50 337.50 75.00
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.00 171.81 57.27
Subtotal (Total Children Is Unduplicated) 27 94.50 4028.78 42.63
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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 4813.75 146016.08 30.33
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Number of Children (Unduplicated) With at Least One Service 1397
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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 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 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
7083 4813.75 146016.08 212.75
Other 0 0.00 0.00 0.00
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Total 7083 4813.75 146016.08 212.75