CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 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 1134 1048.000000 38776.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 421 454.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 585 564.500000 20886.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1238 3125.000000 115625.0000 37.0000
TCON-TCON-TRANSITION CONFERENCE 101 101.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1399 5292.500000 175287.5000 33.1200
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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) 52 53.000000 507.4000 9.5736
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 23 23.000000 202.7300 8.8143
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 52 53.000000 1131.9800 21.3581
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 3 3.000000 170.8200 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 70.9600 23.6533
EXIT-EXIT-EXIT ASSESSMENT 35 50.500000 2525.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 19.500000 1462.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 51.000000 2830.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 76 134.500000 10048.5000 74.7100
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 90 160.000000 12000.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 113 192.500000 14437.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 315 559.500000 31052.2500 55.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.000000 291.0000 48.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 417 1333.500000 78529.6400 58.8899
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 48 102.000000 5100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 4 7.500000 187.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 75 126.750000 6337.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 40 147.250000 7362.5000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 20 74.500000 5057.0600 67.8800
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 238 21801.00000 10900.5000 0.5000
Subtotal (Total Children Is Unduplicated) 254 22264.00000 35195.0600 1.5808
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Total 28890.000000 289012.2000 10.0039
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Number of Children (Unduplicated) With at Least One Service 1426
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Center 03
Flag Claims Units Chgs Paid
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R 40 31.000000 1324.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1803 1245.000000 52756.3600 9.2500
P 1568 991.750000 41511.2500 41511.2550
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
8363 26487.250000 191335.9500 0.0000
Other 135 135.000000 2083.8900 0.0000
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Total 11909 28890.000000 289012.2000 41520.5050