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
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 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 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 15.805870 1185.4403 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 26 46.805870 2928.2503 62.5616
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.850000 1735.3400 450.7377
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 3 5.000000 125.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 10 82.000000 4100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 77 453.750000 22687.5000 50.0000
INTR-INTR-INTERPRETER 1 1.500000 75.0000 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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 151.636270 10293.0700 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 500 129796.0000 64898.0000 0.5000
Subtotal (Total Children Is Unduplicated) 509 131155.7629 139170.6395 1.0611
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Total 131202.818797 142108.1398 1.0831
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Number of Children (Unduplicated) With at Least One Service 509
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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 1184 44227.000000 46988.2200 46988.2200
T 1223 45453.500000 48593.9200 48593.9200
1182 41522.318797 46525.9998 0.5000
Other 0 0.000000 0.0000 0.0000
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Total 3589 131202.818797 142108.1398 95582.6400