CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 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 1134 1048.000000 38776.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 421 454.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 585 564.500000 20886.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 550 1336.750000 49459.7500 37.0000
TCON-TCON-TRANSITION CONFERENCE 101 101.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1311 3504.250000 109122.2500 31.1400
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.000000 59.2100 9.8683
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.000000 33.6400 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 126.7300 21.1217
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 56.9400 56.9400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 24.4700
EXIT-EXIT-EXIT ASSESSMENT 35 50.500000 2525.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.000000 675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 41.500000 2303.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 62.000000 4611.0000 74.3710
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 35 65.500000 4912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 48 84.500000 6337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 201 365.000000 20257.5000 55.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 273 713.500000 43129.2400 60.4474
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 48 102.000000 5100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 4 7.500000 187.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 75 126.750000 6337.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 50.000000 2500.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 8 27.000000 1832.7600 67.8800
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 238 21801.00000 10900.5000 0.5000
Subtotal (Total Children Is Unduplicated) 254 22119.25000 27108.2600 1.2256
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Total 26337.000000 179359.7500 6.8102
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Number of Children (Unduplicated) With at Least One Service 1353
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Center 03
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 0 0.000000 0.0000 0.0000
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
8242 26319.000000 179058.7600 0.0000
Other 18 18.000000 300.9900 0.0000
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Total 8260 26337.000000 179359.7500 0.0000