CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/15/2012 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 985 670.000000 24790.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 502 605.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 230 210.500000 7788.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1305 3496.250000 129361.2500 37.0000
TCON-TCON-TRANSITION CONFERENCE 89 89.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1376 5070.750000 161939.7500 31.9361
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 15.2500 15.2500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 66 66.000000 546.4800 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 10 10.000000 103.8000 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 65 65.000000 1370.2000 21.0800
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.000000 155.2800 51.7600
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.000000 163.1400 27.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 30.3100 30.3100
EXIT-EXIT-TRANSITION ASSESSMENT 53 75.250000 3762.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 76 130.500000 9787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 64 114.500000 8587.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 42 69.000000 5175.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 99 161.000000 8935.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 41 41.000000 2050.0000 50.0000
Subtotal (Total Children Is Unduplicated) 311 772.250000 42635.9600 55.2100
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 10 16.000000 800.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 9.000000 450.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 29.000000 1450.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 14.750000 737.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 7.750000 526.0700 67.8800
PHY-97110-PT SESSION BY LICENSED PT 3 22.750000 1544.2700 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 34 2267.000000 1133.5000 0.5000
Subtotal (Total Children Is Unduplicated) 50 2367.250000 6691.3400 2.8266
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Total 8210.250000 211267.0500 25.7321
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Number of Children (Unduplicated) With at Least One Service 1384
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Center 03
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 51 26.000000 1046.7500 0.0000
P 3625 2215.250000 88447.0000 88437.7500
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 4266 2303.250000 71626.6700 71626.6700
2245 3523.500000 47830.8400 0.0000
Other 143 142.250000 2315.7900 0.0000
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Total 10330 8210.250000 211267.0500 160064.4200