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
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 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 447 1732.000000 64084.0000 37.0000
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 673 2035.500000 75202.5000 36.9455
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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 2 2.500000 187.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 86 108.500000 8137.5000 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 93 147.000000 8158.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 10.000000 750.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 7 7.000000 339.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.000000 242.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 3 3.000000 145.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 5 6.000000 291.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 20 19.381400 940.0000 48.5001
Subtotal (Total Children Is Unduplicated) 225 408.881400 24273.7500 59.3662
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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 35 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 289 2559.250000 127962.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 96.500000 6550.4200 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 3 13.500000 733.3200 54.3200
PHY-97110-PT SESSION BY LICENSED PT 32 117.250000 7958.9300 67.8800
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 108.6400 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 108 537.671300 36497.1300 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 21 65.131800 3537.9600 54.3200
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 793 156317.0000 81413.9000 0.5208
Subtotal (Total Children Is Unduplicated) 869 159746.3031 266662.8000 1.6693
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Total 162190.684500 366139.0500 2.2575
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Number of Children (Unduplicated) With at Least One Service 1110
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Center 57
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 1 1.000000 37.0000 37.0000
D 14 11.000000 407.0000 0.0000
S 45 1289.500000 2778.1400 2778.1400
H 0 0.000000 0.0000 0.0000
T 3242 158508.184500 266375.2800 266375.2800
2586 2381.000000 96541.6300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5888 162190.684500 366139.0500 269190.4200