CMS/EIP Fiscal Report Center: 09
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 903 1436.750000 53113.5000 36.9678
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 911 1007.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 729 598.500000 22144.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1727 7198.500000 266216.0000 36.9821
TCON-TCON-TRANSITION CONFERENCE 206 205.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1782 10445.75000 341474.0000 32.6902
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 77 143.000000 7150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 40 78.500000 5887.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 22.000000 1650.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 12.000000 900.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 33 64.500000 4837.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 47.500000 2636.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 149 272.000000 20400.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 132 220.000000 16500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 57 106.000000 7950.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 253 473.000000 26251.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 50 93.500000 7012.5000 75.0000
Subtotal (Total Children Is Unduplicated) 456 1532.000000 101175.2500 66.0413
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 42 56.000000 2800.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 1.250000 62.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 9.500000 475.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 83 66.750000 3337.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 101.000000 5050.0000 50.0000
INTR-INTR-INTERPRETER 119 201.750000 10087.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 26.250000 1781.8500 67.8800
PHY-97110-PT SESSION BY LICENSED PT 33 172.750000 11726.2700 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 101 593.000000 40252.8400 67.8800
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 250 24384.00000 12162.5000 0.4988
Subtotal (Total Children Is Unduplicated) 394 25614.50000 87817.2100 3.4284
-----------------------------------------------------------------------------------------------------------------------
Total 37592.250000 530466.4600 14.1111
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1801
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 4.750000 175.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5087 5015.500000 219463.5800 0.0000
P 10152 31622.000000 257198.7500 257198.7500
D 0 0.000000 0.0000 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
643 950.000000 53628.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15887 37592.250000 530466.4600 257198.7500