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:EIP DEI DEIP
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 293 330.000000 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 3876.000000 128473.2500 33.1458
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
EXIT-EXIT-TRANSITION ASSESSMENT 67 125.500000 6275.0000 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 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 54.000000 2997.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 40.000000 3000.0000 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 90 177.500000 9851.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 38.000000 2850.0000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 203 523.000000 31287.7500 59.8236
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 232.4500 77.4833
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 78 112.750000 5637.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 19 14.250000 356.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 113 95.250000 4762.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 5 4.500000 112.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 11.000000 550.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 32 33.000000 1650.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 19.750000 987.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.750000 68.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 20.000000 500.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 120 515.250000 25762.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 8.000000 400.0000 50.0000
INTR-INTR-INTERPRETER 1 2.000000 100.0000 50.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 18.000000 900.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 203.6400 67.8800
TRAN-TRAN-FAMILY TRANSPORTATION 1 60.000000 6000.0000 100.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 345 43130.00000 21444.5000 0.4972
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 2 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 388 44057.25000 69861.8400 1.5857
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Total 48456.250000 229622.8400 4.7388
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Number of Children (Unduplicated) With at Least One Service 719
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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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4497 45781.801000 119233.6400 0.0000
Other 5 5.000000 250.0000 0.0000
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Total 7381 48456.250000 229622.8400 60355.7000