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
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 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 2450.250000 90659.2500 37.0000
Subtotal (Total Children Is Unduplicated) 885 2593.750000 95968.7500 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 101 101.000000 5050.0000 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
Subtotal (Total Children Is Unduplicated) 360 857.000000 54223.2500 63.2710
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 6.000000 300.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 18.000000 1221.8400 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 140.000000 74.0000 0.5286
Subtotal (Total Children Is Unduplicated) 6 164.000000 1595.8400 9.7307
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Total 3614.750000 151787.8400 41.9912
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Number of Children (Unduplicated) With at Least One Service 946
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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 1114 1045.750000 43500.5000 0.0000
P 826 899.000000 40514.0000 40514.0000
D 6 6.750000 249.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 5 7.750000 495.7500 0.0000
T 3 140.000000 74.0000 74.0000
1675 1514.500000 66916.8400 435.7600
Other 0 0.000000 0.0000 0.0000
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Total 3631 3614.750000 151787.8400 41023.7600