CMS/EIP Fiscal Report Center: 57
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 92 46.000000 1702.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 124 97.500000 3607.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 350 934.000000 34558.0000 37.0000
Subtotal (Total Children Is Unduplicated) 464 1077.500000 39867.5000 37.0000
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 3.500000 175.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 108 108.000000 5400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 74 96.500000 7237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 92 145.500000 8075.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 45.000000 3375.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 18 17.187000 833.5700 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 11 11.000000 533.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 24 23.690700 1149.0000 48.5000
Subtotal (Total Children Is Unduplicated) 249 461.877700 27514.5700 59.5711
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 18.000000 900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 93 94.000000 4700.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 292 2545.000000 127250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 37.000000 2511.5600 67.8800
PHY-97110-PT SESSION BY LICENSED PT 24 130.250000 8841.3700 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 68 345.500000 23452.5400 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.500000 27.1600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.000000 26.4000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 1 120.000000 60.0000 0.5000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 749 150888.0000 78759.2000 0.5220
Subtotal (Total Children Is Unduplicated) 828 154182.2500 246628.2300 1.5996
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Total 155721.627700 314010.3000 2.0165
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Number of Children (Unduplicated) With at Least One Service 1018
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Center 57
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 1 1.000000 37.0000 0.0000
P 1 1.250000 46.2500 46.2500
D 6 6.750000 249.7500 0.0000
S 110 5110.000000 6258.3200 6578.3200
H 0 0.000000 0.0000 0.0000
T 2941 148826.127700 241527.9000 242098.1400
1668 1776.500000 65891.0800 622.0000
Other 0 0.000000 0.0000 0.0000
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Total 4727 155721.627700 314010.3000 249344.7100