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: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 841 3338.500000 123433.0000 36.9726
TCON-TCON-TRANSITION CONFERENCE 207 206.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1671 6672.500000 201826.7500 30.2475
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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 12 21.000000 1575.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 22.000000 1650.0000 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 12 22.000000 1221.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 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) 125 264.500000 14922.0000 56.4159
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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 273 1877.500000 93875.0000 50.0000
INTR-INTR-INTERPRETER 139 246.250000 12312.5000 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 1360 272185.0000 136027.0000 0.4998
Subtotal (Total Children Is Unduplicated) 1435 279256.7500 552605.6700 1.9788
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Total 286193.750000 769354.4200 2.6882
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Number of Children (Unduplicated) With at Least One Service 1880
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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 16475 273533.000000 744042.4000 744042.4000
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
474 12660.750000 25312.0200 109.1600
Other 0 0.000000 0.0000 0.0000
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Total 16949 286193.750000 769354.4200 744151.5600