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
Agency Filter:EXT
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 1 0.250000 9.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.250000 9.2500 37.0000
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Screening, Eval, and Assessment,Class #02
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 4 5.000000 250.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 18.500000 1387.5000 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 72 144.500000 10837.5001 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 97.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 4.000000 194.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.000000 533.5000 48.5000
Subtotal (Total Children Is Unduplicated) 109 232.000000 16056.8101 69.2104
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 1822.0800 455.5200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 71.250000 3562.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 26 23.750000 593.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 141 271.250000 13550.0000 49.9539
CONIP-CONIP-CONSULT, ITDS, PHONE 31 14.000000 350.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 12.000000 600.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 17 16.000000 800.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 32 45.000000 2250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 4.000000 100.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 8 31.750000 2327.9100 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 14.000000 350.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 10 82.000000 4100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 374 2458.250000 122912.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 1.000000 50.0000 50.0000
INTR-INTR-INTERPRETER 1 1.500000 75.0000 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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 69 394.250000 26761.6900 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.2000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 500 129910.0000 64955.0000 0.5000
Subtotal (Total Children Is Unduplicated) 512 134144.7500 296993.2187 2.2140
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Total 134376.999980 313059.2788 2.3297
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Number of Children (Unduplicated) With at Least One Service 514
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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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1198 44241.000000 47759.7400 47759.7400
T 1238 45468.500000 49433.3200 49433.3200
4198 44667.499980 215866.2188 272.0200
Other 0 0.000000 0.0000 0.0000
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Total 6634 134376.999980 313059.2788 97465.0800