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
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 466 471.000000 17279.0000 36.6858
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 293 329.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 383 422.250000 15567.7500 36.8686
TCM-T1017TL-TARGETED CASE MANAGEMENT 205 485.500000 17861.7500 36.7904
TCON-TCON-TRANSITION CONFERENCE 51 51.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 629 1758.750000 50708.5000 28.8321
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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 5 11.500000 862.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 20.000000 1110.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 17.805870 1335.4403 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 107 222.805870 12351.2503 55.4350
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 6.850000 1967.7900 287.2686
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 20 22.000000 1100.0000 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 8 18.000000 450.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 10 82.000000 4100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 105 599.051000 29952.5500 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 2.000000 100.0000 50.0000
INTR-INTR-INTERPRETER 2 3.500000 175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 45.026657 3056.4095 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 4 38.000000 2064.1600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 17 87.500000 5939.5000 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 3.000000 150.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 154.636270 10496.7100 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 1 60.000000 6000.0000 100.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 555 172926.0000 86342.5000 0.4993
Subtotal (Total Children Is Unduplicated) 558 174811.0639 189110.0295 1.0818
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Total 176792.619797 252169.7798 1.4264
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Number of Children (Unduplicated) With at Least One Service 707
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Center 53
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 0 0.000000 0.0000 0.0000
D 43 36.750000 1703.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1184 44227.000000 46988.2200 46988.2200
T 1223 45453.500000 48593.9200 48593.9200
5486 87075.369797 154883.8898 0.5000
Other 0 0.000000 0.0000 0.0000
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Total 7936 176792.619797 252169.7798 95582.6400