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
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 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 764 3109.750000 114969.2500 36.9706
TCON-TCON-TRANSITION CONFERENCE 206 205.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1532 6357.000000 190227.2500 29.9241
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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 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 13.000000 975.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 12.500000 937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 93 197.500000 10935.2500 55.3684
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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 9 34.000000 1700.0000 50.0000
INTR-INTR-INTERPRETER 119 201.750000 10087.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 15.000000 1018.2000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 5 16.000000 1086.0800 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 199.000000 13508.1200 67.8800
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 250 24384.00000 12162.5000 0.4988
Subtotal (Total Children Is Unduplicated) 392 24985.50000 46318.6500 1.8538
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Total 31540.000000 247481.1500 7.8466
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Number of Children (Unduplicated) With at Least One Service 1575
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Center 09
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 0 0.000000 0.0000 0.0000
P 9859 31322.500000 242821.8400 242821.8400
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
130 217.500000 4659.3100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9989 31540.000000 247481.1500 242821.8400