CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2012 ending 09/30/2012 Date of Report:11/15/2012 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 37 24.250000 897.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 33 35.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 64 69.500000 2571.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 77 368.750000 13616.0000 36.9247
Subtotal (Total Children Is Unduplicated) 77 497.500000 17084.7500 34.3412
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 80.000000 4440.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 73.000000 5475.0000 75.0000
Subtotal (Total Children Is Unduplicated) 51 167.000000 10906.5000 65.3084
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 51 4615.000000 2307.5000 0.5000
Subtotal (Total Children Is Unduplicated) 51 4615.000000 2307.5000 0.5000
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Total 5279.500000 30298.7500 5.7389
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Number of Children (Unduplicated) With at Least One Service 78
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Center 53
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 9 9.000000 409.0000 0.0000
P 309 385.250000 15909.5000 15909.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 14 467.000000 382.5000 382.5000
T 146 2441.000000 3923.0000 3923.0000
221 1977.250000 9674.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 699 5279.500000 30298.7500 20215.0000