CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/16/2012 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 466 471.250000 17288.2500 36.6859
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 293 330.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 383 422.250000 15567.7500 36.8686
TCM-T1017TL-TARGETED CASE MANAGEMENT 657 2600.750000 95626.5000 36.7688
TCON-TCON-TRANSITION CONFERENCE 51 52.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 698 3876.250000 128482.5000 33.1461
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 20.7600 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 3.000000 63.2400 21.0800
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 30.3100 30.3100
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 3 3.000000 300.0000 100.0000
EXIT-EXIT-TRANSITION ASSESSMENT 70 130.500000 6525.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 48.000000 3600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 30 60.000000 3330.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 58.500000 4387.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 14.000000 975.0000 69.6429
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 100 197.500000 10961.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 91 182.500000 13687.5001 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 97.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 7.000000 339.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.000000 50.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.000000 533.5000 48.5000
Subtotal (Total Children Is Unduplicated) 228 755.000000 47344.5601 62.7080
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 7.000000 2054.5300 293.5043
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 111 184.000000 9200.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 41 38.000000 950.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 155 366.500000 18312.5000 49.9659
CONIP-CONIP-CONSULT, ITDS, PHONE 34 18.500000 462.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 23.000000 1150.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 48 49.000000 2450.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 5 2.750000 68.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 45 64.750000 3237.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 6.750000 168.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 8 31.750000 2327.9100 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 18 34.000000 850.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 10 82.000000 4100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 453 2973.500000 148675.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 9.000000 450.0000 50.0000
INTR-INTR-INTERPRETER 2 3.500000 175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 23 202.999980 13779.6387 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 5 82.000000 4454.2400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 57 460.250000 31241.7700 67.8800
PHY-97110HM-PT SESSION BY PT ASST 11 42.000000 2281.4400 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 18.000000 900.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 69 397.250000 26965.3300 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.2000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 1 60.000000 6000.0000 100.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 555 173040.0000 86399.5000 0.4993
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 2 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 560 178202.0000 366855.0587 2.0586
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Total 182833.249980 542682.1188 2.9682
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Number of Children (Unduplicated) With at Least One Service 734
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Center 53
Flag Claims Units Chgs Paid
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R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 582 648.000000 26122.5000 0.0000
P 1598 1441.949000 60411.2000 60355.7000
D 234 203.750000 8796.5000 0.0000
S 464 375.250000 14790.5000 0.0000
H 1198 44241.000000 47759.7400 47759.7400
T 1238 45468.500000 49433.3200 49433.3200
8695 90449.300980 335099.8588 272.0200
Other 5 5.000000 250.0000 0.0000
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Total 14015 182833.249980 542682.1188 157820.7800