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
Payclass Filters:MED
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 1 0.750000 27.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.750000 27.7500 37.0000
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Screening, Eval, and Assessment,Class #02
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.000000 291.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.000000 291.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 9 9.000000 436.5000 48.5000
Subtotal (Total Children Is Unduplicated) 20 21.000000 1018.5000 48.5000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 451 4125.000000 206250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 54 415.250000 28187.1700 67.8800
PHY-97110-PT SESSION BY LICENSED PT 48 277.750000 18853.6700 67.8800
PHY-97110HM-PT SESSION BY PT ASST 6 28.500000 1548.1200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 70 437.000000 29663.5600 67.8800
Subtotal (Total Children Is Unduplicated) 541 5283.500000 284502.5200 53.8474
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Total 5305.250000 285548.7700 53.8238
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Number of Children (Unduplicated) With at Least One Service 544
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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 0 0.000000 0.0000 0.0000
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 3 9.000000 450.0000 450.0000
1547 5295.500000 285071.0200 285047.2200
Other 0 0.000000 0.0000 0.0000
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Total 1551 5305.250000 285548.7700 285497.2200