CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 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 555 568.500000 20840.7500 36.6592
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 285 334.000000 12321.0000 36.8892
TCM-T1017TL-TARGETED CASE MANAGEMENT 162 289.250000 10646.7500 36.8081
Subtotal (Total Children Is Unduplicated) 595 1191.750000 43808.5000 36.7598
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.750000 137.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 29 32.000000 1600.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 33 61.000000 4537.5000 74.3852
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 24.500000 1837.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 42.500000 2358.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 20.000000 1500.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.000000 97.0000 48.5000
Subtotal (Total Children Is Unduplicated) 79 189.750000 12390.2500 65.2978
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.000000 425.0000 106.2500
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 29 34.000000 1700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 15 12.500000 625.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 17.250000 862.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 11.500000 575.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.250000 31.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 47 270.250000 13512.5000 50.0000
INTR-INTR-INTERPRETER 8 43.000000 2150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 124.750000 8468.0300 67.8800
PHY-97110-PT SESSION BY LICENSED PT 20 80.000000 4769.8900 59.6236
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 70 525.750000 35387.9100 67.3094
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 415 68404.00000 34202.0000 0.5000
Subtotal (Total Children Is Unduplicated) 432 69532.25000 102809.0800 1.4786
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Total 70913.750000 159007.8300 2.2423
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Number of Children (Unduplicated) With at Least One Service 713
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Center 02
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 0 0.000000 0.0000 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 984 31453.000000 53091.5900 53091.5900
3376 39460.750000 105916.2400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4360 70913.750000 159007.8300 53091.5900