CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 834 2825.750000 104552.7500 37.0000
Subtotal (Total Children Is Unduplicated) 834 2825.750000 104552.7500 37.0000
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Screening, Eval, and Assessment,Class #02
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 4 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 52.000000 3900.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 33 64.000000 3552.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 77 213.000000 15975.0000 75.0000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 7 7.000000 350.0000 50.0000
Subtotal (Total Children Is Unduplicated) 103 359.000000 25463.0000 70.9276
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 445 3056.250000 152812.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 27.500000 1866.7000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 2 2.000000 135.7600 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.000000 50.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 55.000000 3733.4000 67.8800
Subtotal (Total Children Is Unduplicated) 457 3141.750000 158598.3600 50.4809
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Total 6326.500000 288614.1100 45.6199
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Number of Children (Unduplicated) With at Least One Service 886
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Center 07
Flag Claims Units Chgs Paid
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R 14 8.250000 305.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 119 72.250000 2673.2500 0.0000
P 4343 2952.750000 116358.5000 116349.2500
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
1223 3293.250000 169277.1100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5699 6326.500000 288614.1100 116349.2500