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
Payclass Filters:TPIN
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 4 4.000000 194.0000 48.5000
EXIT-EXIT-TRANSITION ASSESSMENT 2 5.500000 275.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 33 42.500000 3279.1400 77.1562
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 17.500000 1312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 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 2 1.750000 88.8000 50.7429
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 2.750000 184.4500 67.0727
Subtotal (Total Children Is Unduplicated) 63 90.500000 6486.3900 71.6728
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 12.000000 4855.4600 404.6217
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 6.000000 300.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 2.000000 100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.250000 13.4100 53.6400
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 58 311.750000 16049.8800 51.4832
OCCT-97530-OT SESSION BY LICENSED OT 6 6.750000 511.9200 75.8400
PHY-97110-PT SESSION BY LICENSED PT 23 94.500000 7253.2400 76.7539
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 4.000000 200.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 59 247.750000 18673.1980 75.3711
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 46.000000 23.0000 0.5000
Subtotal (Total Children Is Unduplicated) 144 733.000000 48030.1080 65.5254
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Total 823.500000 54516.4980 66.2010
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Number of Children (Unduplicated) With at Least One Service 194
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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 0 0.000000 0.0000 0.0000
P 17 39.000000 2236.0800 2236.0800
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 2 8.000000 450.0000 500.0000
514 618.250000 43200.5280 0.0000
Other 106 158.250000 8629.8900 0.0000
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Total 639 823.500000 54516.4980 2736.0800