CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2011 ending 09/30/2011 Date of Report:12/01/2011 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 357 224.500000 8306.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 298 351.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 369 357.250000 13190.5000 36.9223
TCM-T1017TL-TARGETED CASE MANAGEMENT 682 2318.250000 85460.7500 36.8643
TCON-TCON-TRANSITION CONFERENCE 47 48.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 703 3299.000000 106957.7500 32.4213
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.0800 21.0800
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 2.000000 200.0000 100.0000
EXIT-EXIT-TRANSITION ASSESSMENT 54 97.250000 4862.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 44.000000 3300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 50.500000 2802.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 57.500000 4312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 25.500000 1912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 76 150.000000 8130.7500 54.2050
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 81 190.500000 14212.5000 74.6063
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 2.000000 100.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 11.000000 533.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.000000 436.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 39 39.000000 1891.5000 48.5000
Subtotal (Total Children Is Unduplicated) 225 706.750000 44686.5800 63.2283
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 5.000000 827.7200 165.5440
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 146 216.750000 10825.0000 49.9423
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 52 83.500000 2087.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 135 351.250000 17550.0000 49.9644
CONIP-CONIP-CONSULT, ITDS, PHONE 35 29.750000 743.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 14.750000 737.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 8 6.750000 168.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 36 41.000000 2050.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 5.250000 131.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 36 55.250000 2762.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 16 8.250000 206.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 6 24.500000 1796.3400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 19 29.500000 737.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 450 2869.000000 143437.0000 49.9955
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 9 45.000000 2250.0000 50.0000
INTR-INTR-INTERPRETER 4 6.250000 312.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 44 336.750000 22858.5900 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 2 5.000000 271.6000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 78 587.499830 39879.4884 67.8800
PHY-97110HM-PT SESSION BY PT ASST 1 4.000000 217.2800 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 20.000000 1000.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 85 587.749990 39841.7893 67.7870
SPL-92508-GROUP SPL SESSION PER CHILD 2 1.000000 13.2000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 558 172452.0000 86013.2500 0.4988
Subtotal (Total Children Is Unduplicated) 565 177820.7498 378468.7577 2.1284
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Total 181826.499820 530113.0877 2.9155
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Number of Children (Unduplicated) With at Least One Service 755
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Center 53
Flag Claims Units Chgs Paid
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R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 87 78.250000 3506.7100 203.5000
P 2113 1810.622200 72468.6100 72468.6100
D 324 275.500000 13916.4800 0.0000
S 1 0.250000 9.2500 0.0000
H 1244 45978.348700 53194.0998 53194.1000
T 2265 50230.250000 69725.3400 69649.5900
7361 83451.778920 317237.0979 357.5000
Other 1 0.500000 18.5000 0.0000
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Total 13397 181826.499820 530113.0877 195873.3000