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: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 903 1436.750000 53113.5000 36.9678
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 911 1007.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 729 598.500000 22144.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 764 3109.750000 114969.2500 36.9706
TCON-TCON-TRANSITION CONFERENCE 206 205.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1532 6357.000000 190227.2500 29.9241
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 88 162.500000 8125.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 17.000000 1275.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 12.500000 937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 6.000000 291.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 7 7.000000 339.5000 48.5000
Subtotal (Total Children Is Unduplicated) 119 242.500000 13398.7500 55.2526
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 152 212.500000 10625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 36 20.750000 518.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 242 200.250000 10012.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 72 69.250000 3462.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 112 101.500000 4995.6800 49.2185
CONPP-CONPP-CONSULT, PT, PHONE 1 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 228 192.000000 9600.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.750000 43.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 273 1877.500000 93875.0000 50.0000
INTR-INTR-INTERPRETER 119 201.750000 10087.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 105 682.750000 44711.5500 65.4874
OCCT-97530HM-OT SESSION BY OT ASST 2 4.000000 217.2800 54.3200
PHY-97110-PT SESSION BY LICENSED PT 117 910.500000 54976.3100 60.3804
PHY-97110HM-PT SESSION BY PT ASST 7 28.500000 1548.1200 54.3200
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 2.000000 105.0000 52.5000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 335 2518.000000 169449.7300 67.2954
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1350 271072.0000 135470.5000 0.4998
Subtotal (Total Children Is Unduplicated) 1409 278098.5000 549786.6700 1.9769
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Total 284698.000000 753412.6700 2.6464
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Number of Children (Unduplicated) With at Least One Service 1734
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Center 09
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 16122 272062.250000 729025.6500 729025.6500
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
453 12635.750000 24387.0200 109.1600
Other 0 0.000000 0.0000 0.0000
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Total 16575 284698.000000 753412.6700 729134.8100