CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 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 1263 2195.500000 81233.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 398 438.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 303 284.750000 10535.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 687 1070.000000 39590.0000 37.0000
TCON-TCON-TRANSITION CONFERENCE 94 94.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1286 4082.250000 131359.2500 32.1781
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 6 6.000000 291.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 41 42.000000 382.6200 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 16 16.000000 149.4400 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 44 45.000000 977.8500 21.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 48.9400 24.4700
EXIT-EXIT-EXIT ASSESSMENT 53 74.000000 3700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.500000 582.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 53 88.500000 6618.7500 74.7881
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 66 117.000000 8775.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 12.500000 918.7500 73.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 140 251.500000 13958.2500 55.5000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 2.1800 2.1800
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.000000 276.2700 46.0450
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.000000 506.5000 46.0455
Subtotal (Total Children Is Unduplicated) 248 700.500000 38371.3000 54.7770
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 46.000000 3045.6800 66.2104
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 194 199.750000 9995.0000 50.0375
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 5 2.750000 68.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 96 130.000000 6500.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 9 4.250000 106.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 63 83.750000 4187.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 53 78.000000 3900.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 113 140.500000 7025.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 8 3.500000 87.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 176 1375.000000 64011.5000 46.5538
INTR-INTR-INTERPRETER 31 575.250000 24460.2800 42.5211
OCCT-97530-OT SESSION BY LICENSED OT 52 396.000000 23295.9400 58.8281
PHY-97110-PT SESSION BY LICENSED PT 41 328.250000 18258.7000 55.6244
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 27.8800 27.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 61 512.500000 23361.0600 45.5826
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 651 157105.0000 78498.0000 0.4997
Subtotal (Total Children Is Unduplicated) 689 160983.0000 266866.5400 1.6577
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Total 165765.750000 436597.0900 2.6338
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Number of Children (Unduplicated) With at Least One Service 1348
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Center 03
Flag Claims Units Chgs Paid
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R 12 7.500000 277.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 313 227.250000 9754.2500 0.0000
P 4934 60203.250000 130493.5700 130522.8200
D 0 0.000000 0.0000 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
12581 105222.750000 294512.9200 0.0000
Other 105 105.000000 1558.8500 0.0000
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Total 17945 165765.750000 436597.0900 130522.8200