CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/15/2012 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 464 278.500000 10304.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 325 327.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 11 7.500000 277.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 357 1388.250000 51365.2500 37.0000
Subtotal (Total Children Is Unduplicated) 865 2001.250000 61947.2500 30.9543
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 46 41.500000 2075.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 67 62.500000 3125.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 23 14.000000 1050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 10.500000 787.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 13.500000 1012.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 7.000000 388.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 111 78.000000 5850.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 2 2.000000 225.5000 112.7500
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 22.1400 22.1400
SPCH-92506-SPEECH EVAL BY LICENSED SLP 13 13.000000 630.5000 48.5000
Subtotal (Total Children Is Unduplicated) 302 250.500000 15651.1400 62.4796
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EI Services,Class #03
TRAN-TRAN-FAMILY TRANSPORTATION 272 278.000000 2224.0000 8.0000
Subtotal (Total Children Is Unduplicated) 272 278.000000 2224.0000 8.0000
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Total 2529.750000 79822.3900 31.5535
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Number of Children (Unduplicated) With at Least One Service 891
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Center 04
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 1 1.000000 185.0000 50.6300
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
3053 2528.750000 79637.3900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3054 2529.750000 79822.3900 50.6300