CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
Payclass Filters:GR
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 48 48.500000 1757.5000 36.2371
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 47 69.500000 2543.7500 36.6007
TCM-T1017TL-TARGETED CASE MANAGEMENT 11 27.500000 999.0000 36.3273
Subtotal (Total Children Is Unduplicated) 54 145.500000 5300.2500 36.4278
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
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 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 9.500000 712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
Subtotal (Total Children Is Unduplicated) 10 29.500000 2134.5000 72.3559
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EI Services,Class #03
INTR-INTR-INTERPRETER 3 7.500000 375.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 38 3382.000000 1691.0000 0.5000
Subtotal (Total Children Is Unduplicated) 38 3389.500000 2066.0000 0.6095
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Total 3564.500000 9500.7500 2.6654
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Number of Children (Unduplicated) With at Least One Service 54
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Center 02
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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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 58 2129.500000 2773.5000 2773.5000
280 1435.000000 6727.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 338 3564.500000 9500.7500 2773.5000