CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/15/2012 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 466 470.750000 17269.7500 36.6856
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 1758.500000 50699.2500 28.8310
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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 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-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 1 2.000000 150.0000 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 7 14.000000 777.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 88 176.000000 9423.0000 53.5398
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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 11 10.000000 500.0000 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 6 13.000000 325.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 37 145.301000 7265.0500 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 2.000000 100.0000 50.0000
INTR-INTR-INTERPRETER 1 2.000000 100.0000 50.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 3.000000 150.0000 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
Subtotal (Total Children Is Unduplicated) 388 43655.30100 49939.3900 1.1439
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Total 45589.801000 110061.6400 2.4142
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Number of Children (Unduplicated) With at Least One Service 668
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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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4304 45553.051000 108357.8900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4347 45589.801000 110061.6400 0.0000