CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1159 4394.750000 162568.7500 36.9916
Subtotal (Total Children Is Unduplicated) 1159 4394.750000 162568.7500 36.9916
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 29 56.000000 4200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 36.000000 2700.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 37.000000 2053.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 150 271.500000 20362.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 120 190.000000 14250.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 59 103.000000 7725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 258 464.000000 25752.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 38.000000 2850.0000 75.0000
Subtotal (Total Children Is Unduplicated) 336 1219.500000 81693.0000 66.9889
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 13 63.000000 3150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 11.250000 763.6500 67.8800
PHY-97110-PT SESSION BY LICENSED PT 26 153.750000 10436.5500 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 151.000000 10249.8800 67.8800
Subtotal (Total Children Is Unduplicated) 76 379.000000 24600.0800 64.9079
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Total 5993.250000 268861.8300 44.8608
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Number of Children (Unduplicated) With at Least One Service 1184
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Center 09
Flag Claims Units Chgs Paid
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R 5 4.750000 175.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5471 5641.500000 251646.0800 0.0000
P 317 347.000000 17040.0000 17040.0000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5793 5993.250000 268861.8300 17040.0000