CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 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 808 352.750000 13051.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 476 497.250000 18398.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2119 5695.500000 210715.0000 36.9968
Subtotal (Total Children Is Unduplicated) 2168 6545.500000 242165.0000 36.9972
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 18 18.000000 826.0000 45.8889
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 27 37.000000 4625.0000 125.0000
EXIT-EXIT-TRANSITION ASSESSMENT 132 309.500000 15475.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 24.500000 1837.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 16 26.000000 1950.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 24.500000 1359.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 142 185.000000 13925.3000 75.2719
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 65.000000 4875.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 136 180.500000 10017.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 160 250.500000 18750.0000 74.8503
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.000000 197.5000 39.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 15 15.000000 773.1000 51.5400
Subtotal (Total Children Is Unduplicated) 454 1142.500000 74735.4000 65.4139
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 20 82.000000 22272.5400 271.6163
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 126 201.500000 10075.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 30 32.000000 1600.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 15 11.000000 275.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.750000 137.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.250000 31.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 11.000000 550.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 13 10.000000 250.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 37 50.000000 2500.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 14.250000 356.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 26 164.000000 4083.5000 24.8994
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 30 151.000000 7550.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 5 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 820 5486.000000 274320.7600 50.0038
INTR-INTR-INTERPRETER 82 489.750000 15347.5000 31.3374
OCCT-97530-OT SESSION BY LICENSED OT 20 133.250000 9066.9800 68.0449
OCCT-97530HM-OT SESSION BY OT ASST 1 3.750000 203.7000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 91 608.000000 41632.9200 68.4752
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 117.500000 5875.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 205 1454.000000 98814.3590 67.9604
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 26.4000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1229 322291.0000 161141.5000 0.5000
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 34 459.750000 22987.5000 50.0000
Subtotal (Total Children Is Unduplicated) 1312 331811.7500 680872.6590 2.0520
-----------------------------------------------------------------------------------------------------------------------
Total 339499.750000 997773.0590 2.9390
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2298
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1440 1061.500000 41129.7500 0.0000
P 8679 209118.750000 363201.9200 363201.9200
D 199 163.750000 8136.2500 0.0000
S 22 26.000000 3025.0000 0.0000
H 40 52.000000 4275.0000 0.0000
T 2829 102055.250000 142189.8710 142193.6200
7238 16166.500000 391090.0980 0.0000
Other 617 10854.000000 44651.1700 0.0000
---------------------------------------------------------
Total 21066 339499.750000 997773.0590 505395.5400