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
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 1 0.500000 18.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 12 20.250000 749.2500 37.0000
Subtotal (Total Children Is Unduplicated) 13 20.750000 767.7500 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 48 48.000000 2328.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 16 16.000000 776.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 23 24.000000 1164.0000 48.5000
Subtotal (Total Children Is Unduplicated) 86 90.000000 4365.0000 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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 189 1605.000000 80250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 116 871.000000 59123.4800 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 108.6400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 45 295.500000 20058.5400 67.8800
PHY-97110HM-PT SESSION BY PT ASST 1 4.500000 244.4400 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 47 315.000000 21382.2000 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 34.000000 1846.8800 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.2000 13.2000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1038 195420.0000 97710.0000 0.5000
Subtotal (Total Children Is Unduplicated) 1092 198608.7500 283699.8800 1.4284
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Total 198719.500000 288832.6300 1.4535
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Number of Children (Unduplicated) With at Least One Service 1104
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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 0 0.000000 0.0000 0.0000
P 4125 198163.750000 280234.9800 277989.4300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 102.500000 201.8200 191.8200
T 0 0.000000 0.0000 0.0000
27 20.750000 767.7500 0.0000
Other 53 432.500000 7628.0800 7356.5600
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Total 4209 198719.500000 288832.6300 285537.8100