CMS/EIP Fiscal Report Center: 53
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 232 157.500000 5827.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 66 67.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 159 159.750000 5910.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 386 863.000000 31931.0000 37.0000
TCON-TCON-TRANSITION CONFERENCE 14 14.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 431 1261.250000 43669.2500 34.6238
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 18 152.000000 7600.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 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 2 4.000000 300.0000 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 8 16.000000 888.0000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 44.000000 2442.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 38.500000 2887.5000 75.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 55 280.500000 15988.0000 56.9982
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 312.0000 312.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 50.750000 2537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 7 3.250000 81.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 82 85.750000 4287.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 6 3.000000 75.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 14.000000 700.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 16.750000 837.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 24.500000 1225.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 9 11.000000 806.5200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 14.000000 350.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 343 1084.000000 54200.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 2.000000 100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 25.000000 1697.0000 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 1 8.000000 434.5600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 24 64.000000 4344.3200 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 7 8.000000 400.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 37.999900 2579.4333 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 393 55693.00000 27846.5000 0.5000
Subtotal (Total Children Is Unduplicated) 409 57147.24990 102845.3333 1.7997
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Total 58688.999900 162502.5833 2.7689
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Number of Children (Unduplicated) With at Least One Service 578
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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 2 2.250000 159.2500 0.0000
P 1063 965.264000 40123.2000 40263.5500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2306 53741.236000 75097.8300 75056.8300
T 0 0.000000 0.0000 0.0000
889 3967.249900 46472.3033 0.0000
Other 13 13.000000 650.0000 0.0000
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Total 4273 58688.999900 162502.5833 115320.3800