CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 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 158 79.500000 2941.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 267 320.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 326 694.250000 25687.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 600 1739.000000 64121.0000 36.8723
TCON-TCON-TRANSITION CONFERENCE 40 42.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 615 2874.750000 92749.7500 32.2636
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 12.3300 12.3300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 6.000000 52.3200 8.7200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 54.0000 10.8000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 6.000000 131.0000 21.8333
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 53.8300 53.8300
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 63.0400 31.5200
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 14 15.000000 1625.0000 108.3333
EXIT-EXIT-TRANSITION ASSESSMENT 62 182.750000 9137.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 35.000000 2625.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 41.500000 2267.2500 54.6325
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 24.499990 1359.7494 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 33 73.500000 5874.4800 79.9249
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 39.499890 2962.4918 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 103 233.499920 13597.8855 58.2351
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 82 262.000000 20253.3000 77.3027
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 16 16.210510 786.2097 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 24 25.000000 1212.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 31 33.000000 2333.0800 70.6994
Subtotal (Total Children Is Unduplicated) 246 1011.460310 65022.9664 64.2862
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 24.000000 3653.1000 152.2125
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 2.000000 143.2200 71.6100
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 99 262.000000 13100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 26 30.000000 750.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 8.500000 425.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 14.000000 700.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 8.000000 400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 9.000000 660.7800 73.4200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 22 47.000000 1175.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 28 110.000000 5500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 382 2488.250000 124314.5000 49.9606
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 25.000000 1250.0000 50.0000
INTR-INTR-INTERPRETER 10 14.000000 700.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 46 232.750000 15799.0700 67.8800
PHY-97110-PT SESSION BY LICENSED PT 66 494.250000 33549.6900 67.8800
RSPT-RSPT-RESPITE 1 40.000000 0.0000 0.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 4.000000 200.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 97 554.500000 37639.4600 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 4 13.750000 181.5000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 1 20.000000 2000.0000 100.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 523 120184.0000 60056.5000 0.4997
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 2 9.000000 450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 551 124600.0000 302822.8200 2.4304
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Total 128486.210310 460595.5364 3.5848
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Number of Children (Unduplicated) With at Least One Service 746
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Center 53
Flag Claims Units Chgs Paid
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R 80 83.250000 3321.2500 311.0000
U 0 0.000000 0.0000 0.0000
B 1139 1052.500000 43377.0000 0.0000
P 544 604.529578 29887.3759 29099.8800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1306 41539.716930 66034.1396 66017.0200
T 1456 32202.250000 58070.9800 58070.9800
5457 52999.463802 259701.2909 37.5000
Other 3 4.500000 203.5000 0.0000
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Total 9985 128486.210310 460595.5364 153536.3800