CMS/EIP Fiscal Report Center: 07
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
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 962 797.500000 29507.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 56 58.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 567 795.500000 29433.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1260 4333.000000 160321.0000 37.0000
TCON-TCON-TRANSITION CONFERENCE 17 17.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1363 6001.000000 219262.0000 36.5376
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 15 24.750000 1237.5000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 25.000000 1875.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 80.500000 4467.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 90 239.500000 17962.5000 75.0000
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.000000 72.7800 72.7800
NUTR-97802-NUTRITIONAL EVAL, INITIAL 3 2.000000 100.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 1.000000 50.0000 50.0000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 13 13.000000 650.0000 50.0000
Subtotal (Total Children Is Unduplicated) 128 398.750000 27226.5300 68.2797
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.500000 125.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 3.000000 150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 7 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 0.750000 37.5000 50.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.000000 50.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 64 4156.000000 2063.0000 0.4964
Subtotal (Total Children Is Unduplicated) 73 4167.250000 2525.5000 0.6060
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Total 10567.000000 249014.0300 23.5653
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Number of Children (Unduplicated) With at Least One Service 1363
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Center 07
Flag Claims Units Chgs Paid
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R 14 8.250000 305.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 119 72.250000 2673.2500 0.0000
P 4343 2952.750000 116358.5000 116349.2500
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
5857 7533.750000 129677.0300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10333 10567.000000 249014.0300 116349.2500