CMS/EIP Fiscal Report Center: 53
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 422 378.500000 13958.2500 36.8778
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 260 299.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 397 496.750000 18278.0000 36.7952
TCM-T1017TL-TARGETED CASE MANAGEMENT 685 2406.750000 88346.7500 36.7079
TCON-TCON-TRANSITION CONFERENCE 74 75.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 718 3656.000000 120583.0000 32.9822
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 6.000000 62.2800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 6.000000 126.4800 21.0800
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 30.3100 30.3100
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 12 12.000000 1350.0000 112.5000
EXIT-EXIT-TRANSITION ASSESSMENT 59 108.000000 5400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 31.000000 2325.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 17.000000 1237.5000 72.7941
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 45.000000 2489.2500 55.3167
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 28.000000 2100.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 28.000000 2100.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 86 171.500000 9507.2500 55.4359
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 86 200.000000 15000.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 6.999990 339.4995 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 9.000000 436.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.000000 50.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 21 22.000000 1067.0000 48.5000
Subtotal (Total Children Is Unduplicated) 223 694.499990 43718.0695 62.9490
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 12.000000 2813.5500 234.4625
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 93 139.500000 6975.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 32 29.000000 725.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 141 298.750000 14931.2500 49.9791
CONIP-CONIP-CONSULT, ITDS, PHONE 34 19.500000 487.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 6.000000 300.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 48.000000 2400.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 35 52.250000 2612.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 11 37.500000 937.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 21.000000 1539.7200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 34.000000 850.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 9 60.000000 3000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 443 2965.750000 148287.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 24.000000 1200.0000 50.0000
INTR-INTR-INTERPRETER 3 5.500000 295.0000 53.6364
OCCT-97530-OT SESSION BY LICENSED OT 42 349.249900 23707.0830 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 7 85.000000 4617.2000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 61 477.499970 32399.1379 67.8516
PHY-97110HM-PT SESSION BY PT ASST 2 11.000000 597.5200 54.3200
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 25.000000 1250.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 78 485.000000 32921.8000 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 52.8000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 554 171477.0000 85651.0000 0.4995
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 566 176671.2499 368705.8109 2.0870
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Total 181021.749860 533006.8804 2.9444
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Number of Children (Unduplicated) With at Least One Service 774
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Center 53
Flag Claims Units Chgs Paid
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R 8 6.000000 222.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 53 40.500000 1613.5000 9.2500
P 4309 50898.750000 142548.2300 142682.6800
D 216 224.500000 12178.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 1237 48484.512670 52726.6400 52726.6400
T 793 600.500000 17787.7500 17787.7500
6881 80766.987190 305929.8604 200.0000
Other 0 0.000000 0.0000 0.0000
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Total 13497 181021.749860 533006.8804 213406.3200