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
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 468 1860.000000 68626.7500 36.8961
Subtotal (Total Children Is Unduplicated) 468 1860.000000 68626.7500 36.8961
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 32.000000 2400.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 36.000000 1998.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 17.000000 1275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 57 111.500000 6188.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 33.000000 2399.0000 72.6970
Subtotal (Total Children Is Unduplicated) 91 262.500000 16735.2500 63.7533
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 93 342.500000 17125.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 10.000000 500.0000 50.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 21.500000 1075.0000 50.0000
Subtotal (Total Children Is Unduplicated) 109 383.000000 18925.0000 49.4125
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Total 2505.500000 104287.0000 41.6232
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Number of Children (Unduplicated) With at Least One Service 476
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Center 53
Flag Claims Units Chgs Paid
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R 1 1.000000 50.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 674 552.250000 20484.5000 37.0000
P 1945 1880.750000 80034.5000 79997.0000
D 1 2.000000 150.0000 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
24 27.000000 1168.0000 0.0000
Other 38 42.500000 2400.0000 0.0000
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Total 2683 2505.500000 104287.0000 80034.0000