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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 942 1475.000000 54528.7500 36.9686
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 912 1008.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 811 645.000000 23865.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1904 7766.250000 287222.7500 36.9835
TCON-TCON-TRANSITION CONFERENCE 207 206.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1964 11100.25000 365616.5000 32.9377
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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 49 93.500000 7012.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 23.000000 1725.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 21.000000 1575.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 34 66.500000 4987.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 55.000000 3052.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 267 477.000000 35775.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 180 296.500000 22237.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 124 217.500000 16312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 372 681.000000 37795.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 68 123.000000 9225.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 9 10.000000 485.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 8.000000 388.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.000000 533.5000 48.5000
Subtotal (Total Children Is Unduplicated) 648 2246.500000 149278.0000 66.4491
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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 229 192.750000 9637.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.750000 43.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 817 5757.500000 287875.0000 50.0000
INTR-INTR-INTERPRETER 139 246.250000 12312.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 175 1093.500000 72593.2600 66.3862
OCCT-97530HM-OT SESSION BY OT ASST 3 6.000000 325.9200 54.3200
PHY-97110-PT SESSION BY LICENSED PT 247 1968.000000 126759.4100 64.4103
PHY-97110HM-PT SESSION BY PT ASST 28 164.500000 8935.6400 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 513 3679.750000 248309.3200 67.4799
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1360 272185.0000 136027.0000 0.4998
Subtotal (Total Children Is Unduplicated) 1464 285904.7500 932626.2300 3.2620
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Total 299251.500000 1447520.7300 4.8371
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Number of Children (Unduplicated) With at Least One Service 2040
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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 16855 274028.000000 770229.7200 770229.7230
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
3290 19577.250000 425469.1800 908.9600
Other 0 0.000000 0.0000 0.0000
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Total 25621 299251.500000 1447520.7300 771138.6830