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
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 92 46.000000 1702.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 124 97.500000 3607.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 350 933.250000 34530.2500 37.0000
Subtotal (Total Children Is Unduplicated) 464 1076.750000 39839.7500 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 3 3.500000 262.5000 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 4 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 74 96.500000 7237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 92 145.500000 8075.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 45.000000 3375.0000 75.0000
Subtotal (Total Children Is Unduplicated) 205 403.000000 24648.5000 61.1625
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 16.000000 1086.0800 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 140.000000 74.0000 0.5286
Subtotal (Total Children Is Unduplicated) 5 156.000000 1160.0800 7.4364
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Total 1635.750000 65648.3300 40.1335
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Number of Children (Unduplicated) With at Least One Service 542
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Center 57
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 1 1.000000 37.0000 0.0000
P 1 1.250000 46.2500 46.2500
D 6 6.750000 249.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 140.000000 74.0000 74.0000
1658 1486.750000 65241.3300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1669 1635.750000 65648.3300 120.2500