CMS/EIP Fiscal Report Center: 06
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 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 1451 4726.500000 174843.5000 36.9922
Subtotal (Total Children Is Unduplicated) 1472 5874.500000 217057.2500 36.9491
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 105 107.000000 885.9600 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 103 105.000000 1089.9000 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 104 106.000000 2234.4800 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 108.7600 27.1900
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 12.500000 937.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.500000 712.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 208 324.000000 24300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 178 277.000000 20775.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 65.000000 4875.0000 75.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 7 7.000000 400.8900 57.2700
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 246 1021.000000 56566.9900 55.4035
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Total 6895.500000 273624.2400 39.6816
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Number of Children (Unduplicated) With at Least One Service 1472
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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 2681 1936.000000 71632.0000 0.0000
P 1263 872.250000 32236.2500 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 0 0.000000 0.0000 0.0000
5657 4087.250000 169755.9900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9601 6895.500000 273624.2400 0.0000