CMS/EIP Fiscal Report Center: 09
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 748 817.000000 30219.7500 36.9887
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 717 814.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 691 704.250000 26048.0000 36.9869
TCM-T1017TL-TARGETED CASE MANAGEMENT 1596 7174.000000 265077.2500 36.9497
TCON-TCON-TRANSITION CONFERENCE 172 174.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1617 9683.250000 321345.0000 33.1857
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 103 188.000000 9400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 47 90.500000 6787.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 21.500000 1612.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 26 49.500000 3712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 47.500000 2636.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 182 345.000000 25800.0000 74.7826
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 107 195.500000 14587.5000 74.6164
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 70 135.500000 10162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 195 375.000000 20757.0000 55.3520
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 72.000000 5400.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.000000 242.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 4.000000 194.0000 48.5000
Subtotal (Total Children Is Unduplicated) 432 1546.500000 102498.7500 66.2779
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.000000 110.9000 36.9667
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 61 98.250000 4912.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 11 7.250000 181.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 70 59.250000 2962.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 7 5.500000 137.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 8.500000 425.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 11.000000 550.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 69 70.000000 3500.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 3.500000 87.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 583 4523.250000 226162.5000 50.0000
INTR-INTR-INTERPRETER 134 234.750000 11712.5000 49.8935
OCCT-97530-OT SESSION BY LICENSED OT 219 1534.500000 103632.6400 67.5351
OCCT-97530HM-OT SESSION BY OT ASST 2 8.000000 434.5600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 313 2123.000000 142020.8900 66.8963
PHY-97110HM-PT SESSION BY PT ASST 17 108.250000 5834.3800 53.8973
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.000000 50.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 574 4506.250000 305582.7200 67.8131
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1000 254147.0000 127046.5000 0.4999
Subtotal (Total Children Is Unduplicated) 1243 267452.2500 935343.8400 3.4972
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Total 278682.000000 1359187.5900 4.8772
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Number of Children (Unduplicated) With at Least One Service 1682
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Center 09
Flag Claims Units Chgs Paid
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R 3 1.750000 64.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5407 5075.250000 219719.4800 0.0000
P 14237 262871.750000 754381.5100 754551.5450
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
2604 10731.500000 384957.1000 831.4600
Other 3 1.750000 64.7500 0.0000
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Total 22254 278682.000000 1359187.5900 755383.0050