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
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 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 686 2833.250000 104589.7500 36.9151
TCON-TCON-TRANSITION CONFERENCE 172 174.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1365 5342.500000 160857.5000 30.1090
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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 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 27.500000 2062.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 14.000000 1050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 33.000000 1831.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 145.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 135 307.500000 17455.5000 56.7659
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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 97.250000 4862.5000 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 212 1634.500000 81725.0000 50.0000
INTR-INTR-INTERPRETER 134 234.750000 11712.5000 49.8935
OCCT-97530-OT SESSION BY LICENSED OT 114 844.500000 56795.4400 67.2533
OCCT-97530HM-OT SESSION BY OT ASST 2 8.000000 434.5600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 143 1002.250000 65944.3800 65.7963
PHY-97110HM-PT SESSION BY PT ASST 9 44.750000 2385.0600 53.2974
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.000000 50.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 361 2980.250000 201997.8400 67.7788
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1000 254147.0000 127046.5000 0.4999
Subtotal (Total Children Is Unduplicated) 1155 261162.2500 560908.4300 2.1477
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Total 266812.250000 739221.4300 2.7706
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Number of Children (Unduplicated) With at Least One Service 1545
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Center 09
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 13747 262285.250000 728408.9900 728408.9900
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
184 4527.000000 10812.4400 831.4600
Other 0 0.000000 0.0000 0.0000
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Total 13931 266812.250000 739221.4300 729240.4500