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: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 833 3352.750000 123977.7500 36.9779
TCON-TCON-TRANSITION CONFERENCE 246 247.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1682 6562.250000 197848.2500 30.1495
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 62 119.250000 5962.5000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 21.500000 1612.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 28.500000 1581.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 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) 96 213.250000 12083.0000 56.6612
-----------------------------------------------------------------------------------------------------------------------
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 134 215.250000 10762.5000 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 1285 245996.0000 122998.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1403 252387.2500 507428.5600 2.0105
-----------------------------------------------------------------------------------------------------------------------
Total 259162.750000 717359.8100 2.7680
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1890
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 15826 253727.750000 699466.2300 699466.2300
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
295 5435.000000 17893.5800 233.5800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16121 259162.750000 717359.8100 699699.8100