CMS/EIP Fiscal Report Center: 57
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 212 124.500000 4606.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 192 176.000000 6512.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1134 4527.500000 167517.5000 37.0000
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1146 4831.000000 178636.0000 36.9770
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 94 94.500000 4725.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 10.500000 787.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 15.500000 860.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 202 239.000000 17925.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 221 336.000000 18648.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 26.000000 1950.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 20 20.000000 970.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 8 8.000000 388.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 11.000000 533.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 14 15.000000 727.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 66 66.000000 3201.0000 48.5000
Subtotal (Total Children Is Unduplicated) 412 847.500000 51140.7500 60.3431
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EI Services,Class #03
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 37 37.000000 1850.0000 50.0000
ECE-ECE-EARLY CHILDHOOD EDUCATION 118 18680.00000 18680.0000 1.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 269.000000 6725.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 767 7012.000000 350600.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 144 892.000000 60548.9600 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 3 19.500000 1059.2400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 153 778.500000 52844.5800 67.8800
PHY-97110HM-PT SESSION BY PT ASST 7 33.500000 1819.7200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 289 1647.500000 111832.3000 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 28 93.500000 5078.9200 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 2 5.500000 72.6000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 830 159398.0000 83006.4000 0.5207
Subtotal (Total Children Is Unduplicated) 1030 188869.0000 694267.7200 3.6759
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Total 194547.500000 924044.4700 4.7497
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Number of Children (Unduplicated) With at Least One Service 1307
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Center 57
Flag Claims Units Chgs Paid
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R 75 75.250000 2784.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1060 1088.500000 48540.2500 0.0000
P 2020 1944.065500 72342.2400 72262.8200
D 15 13.000000 481.0000 0.0000
S 45 1289.500000 2778.1400 2778.1400
H 0 0.000000 0.0000 0.0000
T 3256 158557.684500 268982.8800 268982.8800
5460 31472.750000 526811.2400 343322.4800
Other 15 106.750000 1324.4700 1324.4700
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Total 11946 194547.500000 924044.4700 688670.7900