CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 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
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.500000 18.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 55 85.000000 3145.0000 37.0000
Subtotal (Total Children Is Unduplicated) 56 85.500000 3163.5000 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 19 20.000000 970.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 70 70.000000 3395.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 8 8.000000 388.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 34 34.000000 1649.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 57 59.000000 2861.5000 48.5000
Subtotal (Total Children Is Unduplicated) 165 192.000000 9312.0000 48.5000
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 23 38.750000 1937.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 3.000000 75.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 12.000000 600.0000 50.0000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 3 272.000000 6800.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 73 2202.000000 55050.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1020 9081.000000 454050.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 183 1227.000000 83288.7600 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 2 5.000000 271.6000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 137 677.500000 45988.7000 67.8800
PHY-97110HM-PT SESSION BY PT ASST 2 8.500000 461.7200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 121 610.250000 41423.7700 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 37.000000 2009.8400 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 3 2.000000 26.4000 13.2000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1038 195480.0000 97740.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1189 209663.0000 790073.2900 3.7683
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Total 209940.500000 802548.7900 3.8227
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Number of Children (Unduplicated) With at Least One Service 1196
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Center 04
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 40 31.750000 1174.7500 0.0000
P 4186 198346.250000 286166.6000 281187.5500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2331 7589.000000 379091.8600 348293.9200
T 0 0.000000 0.0000 0.0000
700 3421.500000 120825.9600 0.0000
Other 112 552.000000 15289.6200 15018.1000
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Total 7369 209940.500000 802548.7900 644499.5700