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
Agency Filter:EXT
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.250000 9.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.250000 9.2500 37.0000
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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 73.000000 3650.0000 50.0000
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 4 7.500000 508.5000 67.8000
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 1 1.500000 112.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 53 121.000000 6359.3000 52.5562
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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 31 41.000000 1600.0000 39.0244
CONIF-CONIF-CONSULT, FACE TO FACE 18 31.000000 1125.0000 36.2903
CONIP-CONIP-CONSULT, PHONE 1 4.000000 25.0000 6.2500
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 102 332.500000 12705.0000 38.2105
INTR-T1013-INTERPRETER 6 78.000000 1050.0000 13.4615
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 663 2225.000000 22023.9200 9.8984
OCCT-97530-OT SESSION BY LICENSED OT 17 81.500000 3548.0800 43.5347
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 17 70.500000 4891.6700 69.3854
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 211.000000 11158.3000 52.8829
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) 702 4760.500000 63195.7400 13.2750
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Total 4881.750000 69564.2900 14.2499
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Number of Children (Unduplicated) With at Least One Service 717
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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 2 2.000000 60.0000 0.0000
S 112 115.500000 3928.3400 0.0000
H 0 0.000000 0.0000 0.0000
T 117 148.000000 2427.1800 2307.1800
10 10.250000 219.4200 0.0000
Other 2796 4518.000000 61794.3700 0.0000
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Total 3077 4881.750000 69564.2900 3442.1600