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
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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 16 33.000000 1350.0000 40.9091
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 83.000000 7242.0000 87.2530
Subtotal (Total Children Is Unduplicated) 149 320.500000 19061.7500 59.4750
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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 257 291.250000 14562.5000 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 221 1045.000000 51171.4800 48.9679
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 470 109691.0000 55117.7500 0.5025
Subtotal (Total Children Is Unduplicated) 480 111941.0000 166993.5700 1.4918
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Total 112261.500000 186055.3200 1.6573
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Number of Children (Unduplicated) With at Least One Service 517
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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 0 0.000000 0.0000 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
1122 17209.500000 50326.3300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4287 112261.500000 186055.3200 135728.9900