CMS/EIP Fiscal Report Center: 09
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 70 69.250000 2562.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 116 78.750000 2913.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 272 915.750000 33882.7500 37.0000
Subtotal (Total Children Is Unduplicated) 273 1063.750000 39358.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 34.500000 2587.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 26.500000 1470.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 165 279.000000 20925.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 112.000000 8400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 54 94.000000 7050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 164 291.000000 16150.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 36.500000 2737.5000 75.0000
Subtotal (Total Children Is Unduplicated) 242 891.000000 60633.7500 68.0513
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EI Services,Class #03
INTR-INTR-INTERPRETER 48 82.500000 4125.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 14 1171.000000 585.5000 0.5000
Subtotal (Total Children Is Unduplicated) 59 1253.500000 4710.5000 3.7579
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Total 3208.250000 104703.0000 32.6355
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Number of Children (Unduplicated) With at Least One Service 277
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Center 09
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 642 1016.500000 53361.0000 0.0000
P 639 1737.750000 28375.0000 28338.0000
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 0 0.000000 0.0000 0.0000
198 454.000000 22967.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1479 3208.250000 104703.0000 28338.0000