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
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 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 1 1.000000 48.5000 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-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 41 69.000000 5175.0000 75.0000
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 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 140 251.500000 13958.2500 55.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 229 643.500000 34884.3500 54.2103
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 37 51.750000 2587.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 7.500000 375.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 10.500000 525.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 96.500000 4825.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 12.000000 814.5600 67.8800
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 67.8800 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 100 6521.000000 3260.5000 0.5000
Subtotal (Total Children Is Unduplicated) 138 6702.250000 12505.4400 1.8659
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Total 11428.000000 178749.0400 15.6413
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Number of Children (Unduplicated) With at Least One Service 1291
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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 1788 977.750000 39226.5000 39255.7500
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
7233 10110.500000 127931.9400 0.0000
Other 105 105.000000 1558.8500 0.0000
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Total 9451 11428.000000 178749.0400 39255.7500