CMS/EIP Fiscal Report Center: 09
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 899 1257.500000 46527.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 871 965.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 700 628.750000 23263.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1704 7223.250000 267149.2500 36.9846
TCON-TCON-TRANSITION CONFERENCE 246 247.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1757 10321.50000 336940.5000 32.6445
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 51 92.250000 4612.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 36 71.000000 5325.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 17.000000 1275.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 27 53.000000 3975.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 39.000000 2164.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 132 258.500000 19387.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 130 240.000000 18000.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 89 166.000000 12450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 278 529.000000 29359.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 66.000000 4950.0000 75.0000
Subtotal (Total Children Is Unduplicated) 433 1540.750000 102174.0000 66.3145
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 35 45.000000 2250.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 4 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 6 3.250000 162.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 6.500000 325.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 45 48.500000 2425.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 26 121.000000 6050.0000 50.0000
INTR-INTR-INTERPRETER 112 183.250000 9162.5000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 29 150.250000 10198.9700 67.8800
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 271.6000 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 97 431.000000 29256.2800 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 205 19229.00000 9614.5000 0.5000
Subtotal (Total Children Is Unduplicated) 339 20224.50000 69760.1000 3.4493
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Total 32086.750000 508874.6000 15.8593
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Number of Children (Unduplicated) With at Least One Service 1772
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Center 09
Flag Claims Units Chgs Paid
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R 2 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 5421 5261.750000 228339.2600 0.0000
P 9571 25552.000000 230163.4300 230163.4300
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
579 1270.500000 50279.4100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 15573 32086.750000 508874.6000 230163.4300