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
Agency Filter:EXT
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 2 1.500000 55.5000 37.0000
Subtotal (Total Children Is Unduplicated) 2 1.500000 55.5000 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 7 7.000000 350.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 25 25.000000 1212.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 18 18.000000 873.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 43 46.000000 2231.0000 48.5000
Subtotal (Total Children Is Unduplicated) 80 96.000000 4666.5000 48.6094
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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 94 95.000000 4750.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 994.000000 24850.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 738 6813.000000 340650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 119 820.750000 55712.5100 67.8800
PHY-97110-PT SESSION BY LICENSED PT 134 707.750000 48042.0700 67.8800
PHY-97110HM-PT SESSION BY PT ASST 7 29.500000 1602.4400 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 232 1343.500000 91196.7800 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.500000 27.1600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 5 6.000000 79.2000 13.2000
TRAN-TRAN-FAMILY TRANSPORTATION 1 120.000000 60.0000 0.5000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 749 150928.0000 78775.2000 0.5219
Subtotal (Total Children Is Unduplicated) 1023 161878.0000 646745.3600 3.9953
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Total 161975.500000 651467.3600 4.0220
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Number of Children (Unduplicated) With at Least One Service 1026
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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 0.750000 27.7500 0.0000
P 2 1.122300 54.4300 54.4300
D 0 0.000000 0.0000 0.0000
S 112 5131.000000 6318.3200 6638.3200
H 0 0.000000 0.0000 0.0000
T 2948 148706.127700 242449.4000 243019.6400
2167 7970.500000 402163.1200 309066.1300
Other 12 166.000000 454.3400 454.3400
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Total 5242 161975.500000 651467.3600 559232.8600