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
Payclass Filters:GR
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 601 1484.000000 54908.0000 37.0000
TCON-TCON-TRANSITION CONFERENCE 89 89.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1216 3058.500000 87486.5000 28.6044
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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) 6 6.000000 49.6800 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 20.7600 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 105.4000 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 81.5700 27.1900
EXIT-EXIT-TRANSITION ASSESSMENT 53 75.250000 3762.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 39.500000 2962.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 26.000000 1950.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 50 82.500000 4578.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 29 29.000000 1450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 161 292.250000 16603.9100 56.8141
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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
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 34 2267.000000 1133.5000 0.5000
Subtotal (Total Children Is Unduplicated) 48 2322.000000 3883.5000 1.6725
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Total 5672.750000 107973.9100 19.0338
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Number of Children (Unduplicated) With at Least One Service 1228
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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 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 0 0.000000 0.0000 0.0000
T 4266 2303.250000 71626.6700 71626.6700
2138 3365.500000 36263.5000 0.0000
Other 4 4.000000 83.7400 0.0000
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Total 6408 5672.750000 107973.9100 71626.6700