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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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
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 2 3.500000 262.5000 75.0000
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 14 26.500000 1987.5000 75.0000
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 15 16.000000 776.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 8.000000 388.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 28 29.000000 1406.5000 48.5000
Subtotal (Total Children Is Unduplicated) 82 122.500000 6322.8600 51.6152
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 2314.7700 2314.7700
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 36 37.250000 1862.5000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 4.000000 200.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 2.500000 125.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 6.500000 325.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 6 3.750000 93.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 14 14.750000 737.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 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 45 240.000000 12032.1800 50.1341
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 11 77.000000 3850.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 43 275.500005 18680.6004 67.8062
OCCT-97530HM-OT SESSION BY OT ASST 3 8.250000 448.1400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 82 672.500000 45445.6600 67.5772
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 165 919.149999 62337.3901 67.8207
SPL-92508-GROUP SPL SESSION PER CHILD 2 26.000000 343.2000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 235 61640.00000 30820.0000 0.5000
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 9 27.000000 1350.0000 50.0000
Subtotal (Total Children Is Unduplicated) 278 64271.90000 196155.9205 3.0520
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Total 64394.400004 202478.7805 3.1444
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Number of Children (Unduplicated) With at Least One Service 290
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Center 52
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 380 18359.800212 19749.5300 19749.5300
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
1585 46034.599792 182729.2505 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1965 64394.400004 202478.7805 19749.5300