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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 18 18.000000 826.0000 45.8889
EXIT-EXIT-TRANSITION ASSESSMENT 129 303.500000 15175.0000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 4.000000 222.0000 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 41 46.500000 2580.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 45 70.000000 5250.0000 75.0000
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) 385 740.500000 45935.6500 62.0333
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 20 82.000000 22272.5400 271.6163
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 124 196.000000 9800.0000 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 798 5402.000000 270120.7600 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 1209 318079.0000 159035.5000 0.5000
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 34 459.750000 22987.5000 50.0000
Subtotal (Total Children Is Unduplicated) 1294 327510.2500 674291.6590 2.0588
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Total 328250.750000 720227.3090 2.1941
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Number of Children (Unduplicated) With at Least One Service 1388
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Center 01
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 1 50.000000 25.0000 0.0000
P 4717 206110.500000 247967.1700 247967.1700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2828 102054.000000 142143.6210 142193.6200
2523 9183.250000 285490.3480 0.0000
Other 616 10853.000000 44601.1700 0.0000
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Total 10685 328250.750000 720227.3090 390160.7900