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
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 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 748 3085.250000 114080.2500 36.9760
TCON-TCON-TRANSITION CONFERENCE 246 247.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1520 6183.500000 183871.5000 29.7358
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 51 92.250000 4612.5000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 15.500000 1162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.500000 1026.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
Subtotal (Total Children Is Unduplicated) 65 144.250000 8151.7500 56.5113
-----------------------------------------------------------------------------------------------------------------------
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 10 50.000000 2500.0000 50.0000
INTR-INTR-INTERPRETER 112 183.250000 9162.5000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 7 23.000000 1561.2400 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 166.000000 11268.0800 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 205 19229.00000 9614.5000 0.5000
Subtotal (Total Children Is Unduplicated) 336 19756.25000 39312.5700 1.9899
-----------------------------------------------------------------------------------------------------------------------
Total 26084.000000 231335.8200 8.8689
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1558
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 9550 25526.750000 228653.7800 228653.7800
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
109 557.250000 2682.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9659 26084.000000 231335.8200 228653.7800