CMS/EIP Fiscal Report Center: 52
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 355 227.500000 8417.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 67 71.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 229 172.000000 6364.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 506 1747.500000 64555.7500 36.9418
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 520 2219.000000 79337.2500 35.7536
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 8.2800 8.2800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.0800 21.0800
EXIT-EXIT-TRANSITION ASSESSMENT 4 4.000000 200.0000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 5 10.000000 372.0000 37.2000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 21.500000 1193.2500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 24.000000 838.5000 34.9375
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 70 137.000000 10275.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 49.500000 3712.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 37.500000 2812.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 70 135.000000 7431.5000 55.0481
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 19 20.000000 970.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.000000 436.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 20 20.000000 1000.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 38 39.000000 1891.5000 48.5000
Subtotal (Total Children Is Unduplicated) 179 531.500000 32887.6100 61.8770
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.000000 2874.7200 1437.3600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 58 66.000000 3300.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 29 30.000000 1500.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 9 5.250000 131.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 8.000000 400.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 6 2.250000 56.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 11.000000 550.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 6 3.750000 93.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 28.000000 1400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 24.000000 600.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 200.000000 9415.0000 47.0750
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 84.500000 4225.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 123 648.000000 32419.6800 50.0304
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 11 77.000000 3850.0000 50.0000
INTR-INTR-INTERPRETER 10 107.000000 1408.7500 13.1659
OCCT-97530-OT SESSION BY LICENSED OT 58 337.250005 22872.1904 67.8197
OCCT-97530HM-OT SESSION BY OT ASST 3 8.250000 448.1400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 97 723.250000 48890.5700 67.5984
PHY-97110HM-PT SESSION BY PT ASST 1 1.500000 81.4800 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 5 28.000000 1400.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 207 1122.149999 76117.0301 67.8314
SPL-92508-GROUP SPL SESSION PER CHILD 2 26.000000 343.2000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 367 95049.00000 47609.0000 0.5009
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 9 27.000000 1350.0000 50.0000
Subtotal (Total Children Is Unduplicated) 399 98619.65000 261348.5105 2.6501
-----------------------------------------------------------------------------------------------------------------------
Total 101370.150004 373573.3705 3.6852
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 529
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 504 396.000000 20545.4400 0.0000
P 2218 19614.800212 72464.3000 72464.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 74 136.250000 8765.1400 0.0000
T 0 0.000000 0.0000 0.0000
4841 81081.849792 266095.5005 0.0000
Other 42 141.250000 5702.9900 0.0000
---------------------------------------------------------
Total 7679 101370.150004 373573.3705 72464.3000