CMS/EIP Fiscal Report Center: 09
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 973 4340.750000 160487.5000 36.9723
Subtotal (Total Children Is Unduplicated) 973 4340.750000 160487.5000 36.9723
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 29 57.000000 4275.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 26.000000 1950.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 35.500000 1970.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 101 190.000000 14175.0000 74.6053
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 72 130.000000 9675.0000 74.4231
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 39 76.000000 5700.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 130 248.000000 13708.5000 55.2762
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1312.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 199 803.500000 54422.7500 67.7321
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 381 2814.750000 140737.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 77 462.000000 31360.5600 67.8800
PHY-97110-PT SESSION BY LICENSED PT 131 731.500000 49654.2200 67.8800
PHY-97110HM-PT SESSION BY PT ASST 8 48.000000 2607.3600 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 173 1154.000000 78333.5200 67.8800
Subtotal (Total Children Is Unduplicated) 587 5210.250000 302693.1600 58.0957
-----------------------------------------------------------------------------------------------------------------------
Total 10354.500000 517603.4100 49.9883
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1009
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.750000 64.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5407 5075.250000 219719.4800 0.0000
P 426 410.250000 15341.6300 15335.4750
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
1606 4865.500000 282412.8000 0.0000
Other 3 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 7445 10354.500000 517603.4100 15335.4750