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
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 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 6 7.000000 259.0000 37.0000
Subtotal (Total Children Is Unduplicated) 230 584.000000 21571.0000 36.9366
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.500000 471.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 71.500000 5362.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 41 65.500000 4912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 12.500000 937.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 92 149.500000 8297.2500 55.5000
Subtotal (Total Children Is Unduplicated) 109 312.500000 20356.5000 65.1408
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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 1936.000000 42776.0000 22.0950
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Number of Children (Unduplicated) With at Least One Service 231
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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 0 0.000000 0.0000 0.0000
P 4 7.000000 525.0000 525.0000
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 0 0.000000 0.0000 0.0000
1276 1929.000000 42251.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1280 1936.000000 42776.0000 525.0000