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
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 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 181 301.500000 11155.5000 37.0000
TCON-TCON-TRANSITION CONFERENCE 31 31.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 450 758.500000 23513.5000 31.0000
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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 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 16 32.250000 1977.2500 61.3101
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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 26 68.365600 3418.2800 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 1.000000 50.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 203.6400 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 227 19586.00000 9711.0000 0.4958
Subtotal (Total Children Is Unduplicated) 249 19712.61560 16082.9200 0.8159
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Total 20503.365600 41573.6700 2.0277
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Number of Children (Unduplicated) With at Least One Service 555
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 3 1.250000 46.2500 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1595 20503.365600 41573.6700 41527.4200