CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
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 1221 2474.250000 91519.5000 36.9888
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 887 973.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 903 958.500000 35464.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1625 7959.500000 294410.0000 36.9885
TCON-TCON-TRANSITION CONFERENCE 212 213.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1701 12578.25000 421394.0000 33.5018
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 109 180.750000 9037.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 37 70.000000 5250.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 33 63.000000 4725.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 22.000000 1221.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 151 244.000000 18300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 106 151.000000 11325.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 96 162.500000 12187.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 179 326.500000 18120.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 139 231.000000 17325.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.000000 242.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 6 6.000000 291.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 145.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 477 1481.750000 99286.7500 67.0064
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 190 251.250000 12562.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 40 22.250000 556.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 186 174.750000 8737.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 79 73.000000 3650.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 85 79.250000 3962.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 150 155.000000 7750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 814 5610.000000 280500.0000 50.0000
INTR-INTR-INTERPRETER 161 376.750000 18687.5000 49.6019
OCCT-97530-OT SESSION BY LICENSED OT 171 1257.500000 84311.6500 67.0470
PHY-97110-PT SESSION BY LICENSED PT 271 1832.000000 121783.8500 66.4759
PHY-97110HM-PT SESSION BY PT ASST 20 116.000000 6216.1200 53.5872
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.000000 1000.0000 500.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 501 3633.250000 245663.5400 67.6154
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.000000 26.4000 13.2000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1314 272136.0000 136068.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1432 285726.0000 931600.8100 3.2605
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Total 299786.000000 1452281.5600 4.8444
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Number of Children (Unduplicated) With at Least One Service 1739
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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 6449 5930.500000 252256.4000 55.5000
P 19027 283931.500000 821440.6200 821493.8700
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
2552 9924.000000 378584.5400 80.0000
Other 0 0.000000 0.0000 0.0000
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Total 28028 299786.000000 1452281.5600 821629.3700