CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2012 ending 06/30/2012 Date of Report:08/16/2012 Page: 1
List order: No List
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 426 503.750000 18638.7500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 274 327.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 427 704.000000 26048.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 677 2511.250000 92445.5000 36.8125
TCON-TCON-TRANSITION CONFERENCE 67 68.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 712 4114.000000 137132.2500 33.3331
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.000000 242.5000 48.5000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 10.3800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.0800 21.0800
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 30.3100 30.3100
BEHV-BEHV-BEHAVIORAL ASSESSMENT 3 3.000000 375.0000 125.0000
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.000000 125.0000 125.0000
EXIT-EXIT-TRANSITION ASSESSMENT 62 119.750000 5987.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 28 55.000000 4087.5000 74.3182
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 5 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 56.000000 3108.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 31.500000 2362.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 31.000000 2325.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 17.000000 1275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 96 193.500000 10739.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 89 176.000000 13124.0000 74.5682
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.000000 388.0000 48.5000
Subtotal (Total Children Is Unduplicated) 205 713.750000 45145.0200 63.2505
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 12.000000 3563.0400 296.9200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 93 142.500000 7125.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 36 35.250000 881.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 151 233.500000 11675.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 29 13.000000 325.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 37 54.500000 2656.2500 48.7385
CONOP-CONOP-CONSULT, OT, PHONE 4 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 43 58.500000 2925.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 2.250000 56.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 52 75.750000 3787.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.000000 50.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 11 43.000000 3116.1000 72.4674
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 21.000000 525.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 6 56.000000 2800.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 451 2878.750000 143975.0000 50.0130
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 16.500000 825.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 159.000000 10792.9200 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 3 56.000000 3041.9200 54.3200
PHY-97110-PT SESSION BY LICENSED PT 45 380.500000 25828.3400 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 15 31.500000 1575.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 313.884970 21306.5129 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.000000 26.4000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 542 162061.0000 81023.0000 0.5000
Subtotal (Total Children Is Unduplicated) 549 166650.3850 327929.4829 1.9678
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Total 171478.134970 510206.7529 2.9753
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Number of Children (Unduplicated) With at Least One Service 747
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Center 53
Flag Claims Units Chgs Paid
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R 1 1.000000 50.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 674 552.250000 20484.5000 37.0000
P 3133 47065.331010 129858.2550 129820.7600
D 7 6.000000 298.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1488 50114.693135 52818.4200 52818.4200
7798 73695.860825 304272.5779 168.0000
Other 39 43.000000 2425.0000 0.0000
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Total 13140 171478.134970 510206.7529 182844.1800