CMS/EIP Fiscal Report Center: 52
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
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
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 4 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 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-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 56 110.500000 8287.5000 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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 194.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 20 20.000000 1000.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.000000 485.0000 48.5000
Subtotal (Total Children Is Unduplicated) 145 409.000000 26564.7500 64.9505
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 559.9500 559.9500
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 28.750000 1437.5000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 25 26.000000 1300.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 7 4.500000 112.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.500000 275.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 0.750000 18.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.500000 225.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 13.250000 662.5000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 24.000000 600.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 79 408.000000 20387.5000 49.9694
INTR-INTR-INTERPRETER 10 107.000000 1408.7500 13.1659
OCCT-97530-OT SESSION BY LICENSED OT 15 61.750000 4191.5900 67.8800
PHY-97110-PT SESSION BY LICENSED PT 16 50.750000 3444.9100 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 203.000000 13779.6400 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 224 33409.00000 16789.0000 0.5025
Subtotal (Total Children Is Unduplicated) 225 34347.75000 65192.5900 1.8980
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Total 36975.750000 171094.5900 4.6272
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Number of Children (Unduplicated) With at Least One Service 522
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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 504 396.000000 20545.4400 0.0000
P 1838 1255.000000 52714.7700 52714.7700
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
3256 35047.250000 83366.2500 0.0000
Other 42 141.250000 5702.9900 0.0000
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Total 5714 36975.750000 171094.5900 52714.7700