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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 947 1310.250000 48479.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 872 966.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 797 686.250000 25391.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1900 7848.500000 290283.5000 36.9859
TCON-TCON-TRANSITION CONFERENCE 246 247.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1955 11058.00000 364154.0000 32.9313
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 62 119.250000 5962.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 42 83.000000 6225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 25.000000 1875.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 18.500000 1387.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 28 55.000000 4125.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 55.500000 3080.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 243 460.000000 34500.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 189 338.500000 25387.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 154 279.500000 20962.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 405 761.500000 42263.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 98.500000 7387.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.000000 242.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.000000 194.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 15 15.000000 727.5000 48.5000
Subtotal (Total Children Is Unduplicated) 638 2318.250000 154320.0000 66.5675
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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 787 5363.500000 268175.0000 50.0000
INTR-INTR-INTERPRETER 134 215.250000 10762.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 159 1171.000000 78413.2200 66.9626
PHY-97110-PT SESSION BY LICENSED PT 258 1930.750000 128963.3900 66.7945
PHY-97110HM-PT SESSION BY PT ASST 15 82.000000 4454.2400 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 483 3355.250000 227402.2600 67.7751
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1285 245996.0000 122998.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1449 258739.7500 871912.3600 3.3698
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Total 272116.000000 1390386.3600 5.1095
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Number of Children (Unduplicated) With at Least One Service 2027
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Center 09
Flag Claims Units Chgs Paid
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R 2 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 5859 5979.000000 265543.2600 0.0000
P 15892 253880.000000 708774.1600 708774.1600
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
3011 12254.500000 415976.4400 364.7800
Other 0 0.000000 0.0000 0.0000
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Total 24764 272116.000000 1390386.3600 709138.9400