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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 1.500000 55.5000 37.0000
Subtotal (Total Children Is Unduplicated) 2 3.500000 55.5000 15.8571
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Screening, Eval, and Assessment,Class #02
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 3 4.500000 225.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 39.000000 2164.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 123.000000 9225.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 11.000000 533.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 5.000000 242.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 28 28.000000 1358.0000 48.5000
Subtotal (Total Children Is Unduplicated) 112 235.500000 15619.5800 66.3252
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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 70 97.250000 4862.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 32 29.000000 725.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 117 320.500000 16012.5000 49.9610
CONIP-CONIP-CONSULT, ITDS, PHONE 27 22.500000 562.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 14.250000 712.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 8 6.750000 168.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 10.000000 500.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 5 3.750000 93.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 41.250000 2062.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 9 5.000000 125.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 6 24.500000 1796.3400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 16.000000 400.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 359 2460.000000 123000.0000 50.0000
INTR-INTR-INTERPRETER 1 2.250000 112.5000 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 68 547.999830 37198.2284 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 79 574.749990 39014.0293 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 458 131334.0000 65667.0000 0.5000
Subtotal (Total Children Is Unduplicated) 478 135891.4998 318721.0077 2.3454
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Total 136130.499820 334396.0877 2.4564
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Number of Children (Unduplicated) With at Least One Service 501
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Center 53
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1244 45978.348700 53194.0998 53194.1000
T 1061 36384.750000 41375.5000 41375.5000
4483 53767.401120 239826.4879 82.5000
Other 0 0.000000 0.0000 0.0000
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Total 6788 136130.499820 334396.0877 94652.1000