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
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
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
Subtotal (Total Children Is Unduplicated) 22 98.000000 4906.1600 50.0629
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Total 3159.000000 117900.9100 37.3222
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Number of Children (Unduplicated) With at Least One Service 1189
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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 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 0 0.000000 0.0000 0.0000
4955 3159.000000 117900.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4955 3159.000000 117900.9100 0.0000