CMS/EIP Fiscal Report Center: 05
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 182 76.500000 2830.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 319 360.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 315 287.750000 10646.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 691 2438.500000 90196.7500 36.9886
Subtotal (Total Children Is Unduplicated) 694 3162.750000 103674.0000 32.7797
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 16 34.000000 1380.0000 40.5882
EXIT-EXIT-TRANSITION ASSESSMENT 42 70.000000 3500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 77.2500 77.2500
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 3.000000 114.7500 38.2500
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.000000 189.7500 94.8750
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 63.000000 3316.5000 52.6429
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 20.000000 763.5000 38.1750
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 12.000000 648.7500 54.0625
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 30.500000 1692.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 63 130.500000 10804.5000 82.7931
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.000000 145.5600 72.7800
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 150 373.000000 22899.8100 61.3936
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 97 111.000000 5567.5000 50.1577
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 258 293.250000 14662.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 18 7.000000 175.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 46.500000 2410.0000 51.8280
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 68 46.250000 2312.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 142 130.250000 6632.5000 50.9213
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.500000 37.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 28 111.500000 2578.8200 23.1284
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 223 1047.000000 51271.4800 48.9699
INTR-INTR-INTERPRETER 12 135.500000 6775.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 25.500000 1391.5400 54.5702
PHY-97110-PT SESSION BY LICENSED PT 18 135.750000 8115.6000 59.7834
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 158.750000 10039.6300 63.2418
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 472 109993.0000 55268.7500 0.5025
Subtotal (Total Children Is Unduplicated) 481 112247.0000 167344.5700 1.4909
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Total 115782.750000 293918.3800 2.5385
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Number of Children (Unduplicated) With at Least One Service 715
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Center 05
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 2596 1503.500000 57545.0600 0.0000
P 3165 95052.000000 135728.9900 135728.9900
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 0 0.000000 0.0000 0.0000
3815 19227.250000 100644.3300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9576 115782.750000 293918.3800 135728.9900