CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
Agency Filter:EXT
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 51 60.500000 2238.5000 37.0000
Subtotal (Total Children Is Unduplicated) 51 60.500000 2238.5000 37.0000
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Screening, Eval, and Assessment,Class #02
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 5 5.000000 242.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 14 14.000000 679.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 6 6.000000 291.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 12 12.000000 582.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 14 14.000000 679.0000 48.5000
Subtotal (Total Children Is Unduplicated) 43 51.000000 2473.5000 48.5000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 761 6884.000000 344150.0000 49.9927
OCCT-97530-OT SESSION BY LICENSED OT 39 224.750000 15256.0300 67.8800
PHY-97110-PT SESSION BY LICENSED PT 49 202.750000 13762.6700 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 162.750000 10938.1100 67.2080
Subtotal (Total Children Is Unduplicated) 806 7474.250000 384106.8100 51.3907
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Total 7585.750000 388818.8100 51.2565
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Number of Children (Unduplicated) With at Least One Service 852
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Center 04
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 36 35.250000 1304.2500 0.0000
P 42 25.250000 934.2500 934.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2132 7136.000000 360621.6400 360217.6600
T 0 0.000000 0.0000 0.0000
207 384.250000 25637.1500 0.0000
Other 2 5.000000 321.5200 321.5200
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Total 2419 7585.750000 388818.8100 361473.4300