CMS/EIP Fiscal Report Center: 02
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 22 8.000000 296.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 64.250000 2377.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 52 224.500000 8251.0000 36.7528
Subtotal (Total Children Is Unduplicated) 55 296.750000 10924.2500 36.8130
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 30.000000 2250.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 27.000000 2025.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 14.000000 777.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 27.000000 2025.0000 75.0000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 37 112.500000 8007.2500 71.1756
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 5.000000 250.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 30 3157.000000 1578.5000 0.5000
Subtotal (Total Children Is Unduplicated) 30 3162.000000 1828.5000 0.5783
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Total 3571.250000 20760.0000 5.8131
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Number of Children (Unduplicated) With at Least One Service 55
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Center 02
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 166 168.250000 6188.2500 0.0000
P 0 0.000000 0.0000 0.0000
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 39 1579.500000 1965.0000 1965.0000
233 1823.500000 12606.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 438 3571.250000 20760.0000 1965.0000