CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
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 761 530.750000 19634.5000 36.9939
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 7 7.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 643 610.250000 22579.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 584 1913.000000 70781.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1189 3061.000000 112994.7500 36.9143
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 13 13.000000 107.6400 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 13 13.000000 134.9400 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 13 13.000000 274.0400 21.0800
EXIT-EXIT-TRANSITION ASSESSMENT 4 6.000000 300.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 29.000000 2175.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 23.500000 1762.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 114.5400 57.2700
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 77.0000 38.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 31 109.000000 5428.6600 49.8042
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 303.6200 101.2067
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 38 33.000000 1630.0000 49.3939
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 10 6.750000 156.2500 23.1481
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 3.000000 150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 7.250000 356.2500 49.1379
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 6.500000 325.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 2.500000 62.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 11.000000 550.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 2.000000 50.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 4 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 110 713.250000 35224.0600 49.3853
INTR-INTR-INTERPRETER 56 181.750000 11209.9400 61.6778
OCCT-97530-OT SESSION BY LICENSED OT 30 110.750000 7164.1400 64.6875
OCCT-97530HM-OT SESSION BY OT ASST 7 19.000000 822.0800 43.2674
PHY-97110-PT SESSION BY LICENSED PT 58 274.750000 17057.6700 62.0843
PHY-97110HM-PT SESSION BY PT ASST 2 1.750000 91.6900 52.3943
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 182 889.750000 58583.7000 65.8429
TRAN-TRAN-FAMILY TRANSPORTATION 2 105.000000 77.0000 0.7333
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 588 99731.00000 50022.7500 0.5016
Subtotal (Total Children Is Unduplicated) 667 102137.0000 185586.6500 1.8170
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Total 105307.000000 304010.0600 2.8869
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Number of Children (Unduplicated) With at Least One Service 1332
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Center 06
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 3106 45238.750000 81175.3700 81175.3700
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
9027 60068.250000 222834.6900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 12133 105307.000000 304010.0600 81175.3700