CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 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 786 807.250000 29868.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 413 413.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 14 12.250000 417.2500 34.0612
TCM-T1017TL-TARGETED CASE MANAGEMENT 1430 5352.000000 198024.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1488 6584.500000 228309.5000 34.6738
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 73 69.000000 3450.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 97 85.500000 4275.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 4.500000 337.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 11.500000 862.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 24 21.500000 1612.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 44 41.500000 2303.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 25.500000 1912.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 5.500000 412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 116 76.500000 5737.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 274 244.000000 13542.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 145 109.500000 8212.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 148 148.000000 14563.1900 98.3999
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 21 21.000000 820.7800 39.0848
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 518 872.500000 58584.2200 67.1452
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
TRAN-TRAN-FAMILY TRANSPORTATION 381 390.000000 3120.0000 8.0000
Subtotal (Total Children Is Unduplicated) 381 390.000000 3120.0000 8.0000
-----------------------------------------------------------------------------------------------------------------------
Total 7847.000000 290013.7200 36.9585
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1490
-----------------------------------------------------------------------------------------------------------------------
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 112 62.500000 2312.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1778 1865.500000 71706.5000 0.0000
P 1397 1716.000000 67909.4200 69773.5400
D 36 40.250000 1489.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4739 4160.500000 146512.8000 0.0000
Other 3 2.250000 83.2500 0.0000
---------------------------------------------------------
Total 8065 7847.000000 290013.7200 69773.5400