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
Payclass Filters:GR
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 14 54.500000 1998.0000 36.6606
Subtotal (Total Children Is Unduplicated) 48 126.750000 4671.2500 36.8540
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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-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 6.500000 487.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
Subtotal (Total Children Is Unduplicated) 10 30.500000 2170.5000 71.1639
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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 3319.250000 8670.2500 2.6121
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Number of Children (Unduplicated) With at Least One Service 50
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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 0 0.000000 0.0000 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
175 1739.750000 6705.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 214 3319.250000 8670.2500 1965.0000