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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1263 2195.500000 81233.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 398 438.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 303 284.750000 10535.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 51 61.250000 2266.2500 37.0000
TCON-TCON-TRANSITION CONFERENCE 94 94.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1266 3073.500000 94035.5000 30.5956
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 24.4700
EXIT-EXIT-EXIT ASSESSMENT 53 74.000000 3700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 23.500000 1762.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 54.500000 4087.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 98 175.500000 9740.2500 55.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 162 341.000000 20029.4700 58.7374
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 37 51.750000 2587.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 7.500000 375.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 10.500000 525.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 24.250000 1212.5000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 100 6521.000000 3260.5000 0.5000
Subtotal (Total Children Is Unduplicated) 131 6617.000000 8010.5000 1.2106
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Total 10031.500000 122075.4700 12.1692
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Number of Children (Unduplicated) With at Least One Service 1267
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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 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 0 0.000000 0.0000 0.0000
7181 10030.500000 122051.0000 0.0000
Other 1 1.000000 24.4700 0.0000
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Total 7182 10031.500000 122075.4700 0.0000