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
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1050 4055.750000 150025.7500 36.9909
Subtotal (Total Children Is Unduplicated) 1050 4055.750000 150025.7500 36.9909
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 50.500000 3787.5000 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 17 34.000000 2550.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 33.500000 1859.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 93 170.500000 12787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 90 143.500000 10762.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 40 74.000000 5550.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 173 317.000000 17593.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 27.000000 2025.0000 75.0000
Subtotal (Total Children Is Unduplicated) 237 874.000000 58715.2500 67.1799
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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 5308.750000 233341.0800 43.9541
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Number of Children (Unduplicated) With at Least One Service 1065
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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 5087 5015.500000 219463.5800 0.0000
P 282 288.500000 13701.7500 13701.7500
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 5374 5308.750000 233341.0800 13701.7500