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
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 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 210 664.750000 24558.7500 36.9443
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 461 1136.250000 39340.2500 34.6229
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 4 4.000000 200.0000 50.0000
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 11 22.000000 1650.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 33.500000 1859.2500 55.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 8 8.000000 400.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 42 89.000000 5484.7500 61.6264
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EI Services,Class #03
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 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 20 112.750000 5637.5000 50.0000
INTR-INTR-INTERPRETER 8 95.000000 1168.7500 12.3026
OCCT-97530-OT SESSION BY LICENSED OT 4 17.000000 1153.9600 67.8800
PHY-97110-PT SESSION BY LICENSED PT 4 7.000000 475.1600 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 140.250000 9520.1700 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 224 32792.00000 16346.0000 0.4985
Subtotal (Total Children Is Unduplicated) 225 33248.25000 38357.7900 1.1537
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Total 34473.500000 83182.7900 2.4129
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Number of Children (Unduplicated) With at Least One Service 484
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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 0 0.000000 0.0000 0.0000
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
3164 34334.500000 77614.6500 0.0000
Other 39 139.000000 5568.1400 0.0000
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Total 3203 34473.500000 83182.7900 0.0000