CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/15/2012 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 42 17.000000 629.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 39 35.750000 1322.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 126 477.500000 17667.5000 37.0000
Subtotal (Total Children Is Unduplicated) 127 530.250000 19619.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 9.000000 675.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 39 49.500000 3712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 25.000000 1875.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 50.000000 2775.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 47 73.500000 5512.5000 75.0000
Subtotal (Total Children Is Unduplicated) 81 225.500000 15810.7500 70.1142
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 26.000000 1300.0000 50.0000
INTR-INTR-INTERPRETER 4 6.250000 150.0000 24.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 25 1448.000000 724.0000 0.5000
Subtotal (Total Children Is Unduplicated) 25 1480.250000 2174.0000 1.4687
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Total 2236.000000 37604.0000 16.8175
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Number of Children (Unduplicated) With at Least One Service 128
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Center 01
Flag Claims Units Chgs Paid
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R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 97 81.250000 3342.7500 0.0000
P 264 1340.000000 9767.7500 9758.5000
D 36 41.000000 2171.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 13.000000 975.0000 0.0000
T 13 135.750000 581.0000 581.0000
396 375.000000 13508.5000 0.0000
Other 78 249.500000 7239.5000 0.0000
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Total 894 2236.000000 37604.0000 10339.5000