CMS/EIP Fiscal Report Center: 10
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 3 2.000000 74.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 693 783.750000 28998.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2123 8087.000000 299219.0000 37.0000
Subtotal (Total Children Is Unduplicated) 2123 8872.750000 328291.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 36.500000 2737.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 12.000000 900.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 13.000000 975.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 16.500000 1237.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 25 47.000000 2608.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 164 303.000000 22725.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 69 116.500000 8737.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 73 128.500000 9637.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 203 375.500000 20840.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 121 161.000000 12075.0000 75.0000
Subtotal (Total Children Is Unduplicated) 324 1209.500000 82473.7500 68.1883
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EI Services,Class #03
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 67.8800 67.8800
Subtotal (Total Children Is Unduplicated) 1 1.000000 67.8800 67.8800
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Total 10083.250000 410833.3800 40.7441
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Number of Children (Unduplicated) With at Least One Service 2123
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Center 10
Flag Claims Units Chgs Paid
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R 43 21.250000 900.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1253 1214.250000 66235.0000 5587.0000
P 7627 4640.250000 176376.2500 171431.4100
D 14 14.000000 518.0000 18740.2500
S 83 66.000000 2442.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5565 4127.500000 164361.8800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 14585 10083.250000 410833.3800 195758.6600