CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
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 899 1257.500000 46527.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 871 965.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 700 628.750000 23263.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 748 3085.250000 114080.2500 36.9760
TCON-TCON-TRANSITION CONFERENCE 246 247.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1520 6183.500000 183871.5000 29.7358
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 62 119.250000 5962.5000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 15.500000 1162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.500000 1026.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 145.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 8.000000 388.0000 48.5000
Subtotal (Total Children Is Unduplicated) 89 184.250000 10132.2500 54.9919
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 132 179.000000 8950.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 26 19.250000 481.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 180 154.750000 7737.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 60 57.500000 2875.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 94 82.500000 4075.0000 49.3939
CONPP-CONPP-CONSULT, PT, PHONE 2 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 143 132.000000 6600.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 246 1678.000000 83900.0000 50.0000
INTR-INTR-INTERPRETER 112 184.750000 9237.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 93 704.000000 46713.2600 66.3541
PHY-97110-PT SESSION BY LICENSED PT 116 795.250000 51885.6500 65.2445
PHY-97110HM-PT SESSION BY PT ASST 6 21.000000 1140.7200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 325 2351.750000 159284.6800 67.7303
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1273 244676.0000 122338.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1370 251036.7500 505243.5600 2.0126
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Total 257404.500000 699247.3100 2.7165
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Number of Children (Unduplicated) With at Least One Service 1720
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Center 09
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 15395 251977.250000 681640.4800 681640.4800
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
288 5427.250000 17606.8300 233.5800
Other 0 0.000000 0.0000 0.0000
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Total 15683 257404.500000 699247.3100 681874.0600