CMS/EIP Fiscal Report Center: 04
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
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 620 538.500000 19924.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 360 361.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 11 15.250000 564.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1398 4651.000000 172087.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1429 5565.750000 192575.7500 34.6001
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 67 64.500000 3225.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 87 76.500000 3825.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 7.000000 525.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 20.000000 1110.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 66 34.500000 2587.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 82 56.500000 4237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 243 209.000000 11599.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 131 101.000000 7575.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 126 126.000000 11175.8900 88.6975
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 23 23.000000 1486.0800 64.6122
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.000000 388.0000 48.5000
Subtotal (Total Children Is Unduplicated) 447 746.500000 49271.9700 66.0040
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
TRAN-TRAN-FAMILY TRANSPORTATION 323 329.000000 2632.0000 8.0000
Subtotal (Total Children Is Unduplicated) 323 329.000000 2632.0000 8.0000
-----------------------------------------------------------------------------------------------------------------------
Total 6641.250000 244479.7200 36.8123
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1434
-----------------------------------------------------------------------------------------------------------------------
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 23 31.750000 1174.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 889 1065.250000 41132.5000 0.0000
P 2218 2502.250000 95346.8800 95105.5500
D 22 27.750000 1026.7500 249.7500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3414 3009.500000 105623.0900 0.0000
Other 4 4.750000 175.7500 0.0000
---------------------------------------------------------
Total 6570 6641.250000 244479.7200 95355.3000