CMS/EIP Fiscal Report Center: 54
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 171 62.500000 2312.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 90 92.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 229 271.500000 10045.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 663 1052.500000 38942.5000 37.0000
TCON-TCON-TRANSITION CONFERENCE 31 31.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 686 1509.500000 51300.5000 33.9851
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 6 11.250000 562.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 20.000000 1500.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 18.000000 1350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 29.000000 1609.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 12.000000 900.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 57 113.750000 7450.5000 65.4989
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 2.500000 125.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 43 21.750000 1075.0000 49.4253
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 5.250000 262.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 8.750000 437.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 16.000000 800.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 150 387.500000 19375.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 10.000000 500.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 10.000000 678.8000 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 227 19586.00000 9711.0000 0.4958
Subtotal (Total Children Is Unduplicated) 250 20047.75000 32964.8000 1.6443
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Total 21671.000000 91715.8000 4.2322
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Number of Children (Unduplicated) With at Least One Service 730
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Center 54
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 179 181.000000 9725.6600 0.0000
P 1320 861.522800 34530.8900 34772.8500
D 4 1.750000 64.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1592 20502.115600 41527.4200 41527.4200
T 0 0.000000 0.0000 0.0000
153 112.361600 5204.5800 0.0000
Other 12 12.250000 662.5000 0.0000
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Total 3260 21671.000000 91715.8000 76300.2700