CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
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 92 46.000000 1702.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 124 97.500000 3607.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 878 2451.750000 90714.7500 37.0000
Subtotal (Total Children Is Unduplicated) 885 2595.250000 96024.2500 37.0000
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 3.500000 175.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 108 108.000000 5400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 10.500000 787.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 16.500000 915.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 189 245.000000 18375.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 230 365.000000 20257.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 71 105.000000 7875.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 25 25.000000 1212.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 18 18.000000 873.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 43 46.000000 2231.0000 48.5000
Subtotal (Total Children Is Unduplicated) 429 953.000000 58889.7500 61.7941
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 18.000000 900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 94 95.000000 4750.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 994.000000 24850.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 739 6819.000000 340950.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 119 820.750000 55712.5100 67.8800
PHY-97110-PT SESSION BY LICENSED PT 134 707.750000 48042.0700 67.8800
PHY-97110HM-PT SESSION BY PT ASST 7 29.500000 1602.4400 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 234 1361.500000 92418.6200 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.500000 27.1600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 5 6.000000 79.2000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 1 120.000000 60.0000 0.5000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 751 151068.0000 78849.2000 0.5219
Subtotal (Total Children Is Unduplicated) 1026 162042.0000 648341.2000 4.0011
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Total 165590.250000 803255.2000 4.8509
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Number of Children (Unduplicated) With at Least One Service 1263
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Center 57
Flag Claims Units Chgs Paid
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R 2 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1115 1046.500000 43528.2500 0.0000
P 828 900.122300 40568.4300 40568.4300
D 6 6.750000 249.7500 0.0000
S 112 5131.000000 6318.3200 6638.3200
H 5 7.750000 495.7500 0.0000
T 2951 148846.127700 242523.4000 243093.6400
3842 9485.000000 469079.9600 309501.8900
Other 12 166.000000 454.3400 454.3400
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Total 8873 165590.250000 803255.2000 600256.6200