CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2012 ending 06/30/2012 Date of Report:08/16/2012 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 43 54.750000 2025.7500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 44 44.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 82 98.000000 3626.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 91 443.250000 16344.7500 36.8748
Subtotal (Total Children Is Unduplicated) 92 640.000000 21996.5000 34.3695
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 5.000000 250.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 97.000000 5383.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 101.500000 7612.5000 75.0000
Subtotal (Total Children Is Unduplicated) 64 231.500000 15229.0000 65.7840
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 7.000000 350.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 62 5591.000000 2795.5000 0.5000
Subtotal (Total Children Is Unduplicated) 62 5599.000000 3195.5000 0.5707
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Total 6470.500000 40421.0000 6.2470
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Number of Children (Unduplicated) With at Least One Service 92
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Center 53
Flag Claims Units Chgs Paid
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R 1 1.500000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 80 89.000000 3313.0000 0.0000
P 287 1063.750000 15981.2500 15981.2500
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 45 2061.500000 1390.0000 1390.0000
495 3254.750000 19653.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 908 6470.500000 40421.0000 17371.2500