CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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 668 319.250000 11779.5000 36.8974
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 760 691.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 645 2005.000000 69178.0000 34.5027
Subtotal (Total Children Is Unduplicated) 1470 3016.000000 80957.5000 26.8427
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 31 75.000000 3750.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 193.2500 55.2143
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 20.000000 1304.2500 65.2125
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 32.500000 1720.5000 52.9385
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.000000 600.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 65 154.000000 8642.5500 56.1205
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1070.0000 1070.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 33 43.000000 1700.0000 39.5349
CONIF-CONIF-CONSULT, FACE TO FACE 37 55.500000 2350.0000 42.3423
CONIP-CONIP-CONSULT, PHONE 1 4.000000 25.0000 6.2500
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 111 358.500000 14005.0000 39.0656
INTR-T1013-INTERPRETER 6 78.000000 1050.0000 13.4615
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 664 2227.000000 22043.9200 9.8985
OCCT-97530-OT SESSION BY LICENSED OT 21 91.500000 4262.4800 46.5845
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 18 74.500000 5177.4300 69.4957
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 226.000000 12229.9000 54.1146
SPL-92508-GROUP SPL SESSION PER CHILD 8 235.000000 3261.8000 13.8800
TRAV-TRAVS-Travel by mile 49 1447.000000 643.7700 0.4449
Subtotal (Total Children Is Unduplicated) 727 4844.000000 67912.5000 14.0199
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Total 8014.000000 157512.5500 19.6547
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Number of Children (Unduplicated) With at Least One Service 1724
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Center 01
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 40 88.000000 1134.9800 1134.9800
D 3 4.000000 210.0000 0.0000
S 127 129.250000 4526.0900 0.0000
H 0 0.000000 0.0000 0.0000
T 117 148.000000 2427.1800 2307.1800
4668 3031.250000 81482.8000 0.0000
Other 2882 4613.500000 67731.5000 0.0000
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Total 7837 8014.000000 157512.5500 3442.1600