CMS/EIP Fiscal Report Center: 55
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 285 137.750000 5078.2500 36.8657
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 78 100.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 27.000000 999.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 778 2503.000000 91908.0000 36.7191
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 784 2768.750000 97985.2500 35.3897
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Screening, Eval, and Assessment,Class #02
BEHV-BEHV-BEHAVIORAL ASSESSMENT 9 15.000000 1875.0000 125.0000
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 186.5000 62.1667
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 96 148.000000 11062.5000 74.7466
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 46.500000 3487.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 19.500000 1462.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 32.000000 1776.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 102 153.000000 11437.5000 74.7549
Subtotal (Total Children Is Unduplicated) 149 427.000000 31937.5000 74.7951
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Total 3195.750000 129922.7500 40.6549
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Number of Children (Unduplicated) With at Least One Service 784
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Center 55
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 4 3.000000 111.0000 0.0000
P 1463 1414.750000 56092.2500 56035.1600
D 45 50.750000 3058.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 18 27.000000 2025.0000 0.0000
T 0 0.000000 0.0000 0.0000
2001 1700.250000 68635.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3531 3195.750000 129922.7500 56035.1600