CMS/EIP Fiscal Report Center: 57
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 607 452.000000 16724.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 236 178.250000 6595.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 532 1764.000000 65268.0000 37.0000
Subtotal (Total Children Is Unduplicated) 906 2394.250000 88587.2500 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 112 112.000000 5600.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.500000 249.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 74 88.000000 6600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 8.500000 637.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 97 128.500000 7131.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 47 65.000000 4875.0000 75.0000
Subtotal (Total Children Is Unduplicated) 229 419.500000 26069.0000 62.1430
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 10.000000 678.8000 67.8800
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1 15.000000 10.5000 0.7000
Subtotal (Total Children Is Unduplicated) 3 25.000000 689.3000 27.5720
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Total 2838.750000 115345.5500 40.6325
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Number of Children (Unduplicated) With at Least One Service 936
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Center 57
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 36 30.250000 1317.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 15.000000 10.5000 10.5000
3881 2793.500000 114017.5500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3918 2838.750000 115345.5500 10.5000