CMS/EIP Fiscal Report Center: 53
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 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
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
EXIT-EXIT-TRANSITION ASSESSMENT 53 95.500000 4775.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 30.000000 2250.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 187.5000 62.5000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 22 43.500000 2406.0000 55.3103
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 20.000000 1500.0000 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 75 149.500000 8286.2500 55.4264
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 43.500000 3262.5000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.000000 50.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 169 419.000000 25059.7500 59.8085
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 26.4900 26.4900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 58 86.500000 4325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 15 10.000000 250.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 86 40.250000 2006.2500 49.8447
CONIP-CONIP-CONSULT, ITDS, PHONE 2 2.500000 62.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 26 38.250000 1912.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 14.750000 737.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 34.750000 868.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 23.000000 575.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 111 481.500000 24075.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 17.000000 850.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 54.3200 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 14 25.000000 1250.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 5.000000 339.4000 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 309 35151.00000 17488.0000 0.4975
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 1 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 343 35934.25000 54939.4600 1.5289
-----------------------------------------------------------------------------------------------------------------------
Total 40009.250000 200582.2100 5.0134
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 740
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 3037 2434.500000 90281.9900 90281.9000
D 216 224.500000 12178.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 793 600.500000 17787.7500 17787.7500
2620 36703.250000 78498.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6727 40009.250000 200582.2100 108078.9000