CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 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 229 495.000000 18315.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 95 81.000000 2997.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 129 263.000000 9731.0000 37.0000
Subtotal (Total Children Is Unduplicated) 233 840.000000 31043.0000 36.9560
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 10 10.000000 91.1000 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 46.7000 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 10 10.000000 217.3000 21.7300
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.500000 712.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 15.500000 860.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 68 105.500000 7912.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 80 128.500000 9637.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 17.500000 1312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 141 227.000000 12598.5000 55.5000
Subtotal (Total Children Is Unduplicated) 170 530.500000 33538.8500 63.2212
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
INTR-INTR-INTERPRETER 1 2.000000 70.0000 35.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 12 1032.000000 516.0000 0.5000
Subtotal (Total Children Is Unduplicated) 13 1039.500000 848.5000 0.8163
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Total 2410.000000 65430.3500 27.1495
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Number of Children (Unduplicated) With at Least One Service 235
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Center 03
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 77 86.500000 4393.7500 0.0000
P 376 327.000000 15282.0000 15288.7500
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 0 0.000000 0.0000 0.0000
1302 1971.500000 45399.5000 0.0000
Other 25 25.000000 355.1000 0.0000
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Total 1780 2410.000000 65430.3500 15288.7500