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:EIP DEI DEIP
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 2134 6303.750000 226460.2500 35.9247
Subtotal (Total Children Is Unduplicated) 2172 7314.750000 238239.7500 32.5698
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 13.500000 1012.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 16.500000 1237.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 42.000000 3008.2500 71.6250
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 41 57.000000 4275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 39.500000 2962.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 30.500000 2287.5000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 128 213.500000 15796.8000 73.9897
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.000000 150.0000 50.0000
CONIF-CONIF-CONSULT, FACE TO FACE 20 24.500000 1225.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 20 53.000000 2650.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 2.000000 20.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 20.000000 1428.8000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 16 40.000000 2857.6000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 27.500000 1964.6000 71.4400
Subtotal (Total Children Is Unduplicated) 67 170.000000 10296.0000 60.5647
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Total 7698.250000 264332.5500 34.3367
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Number of Children (Unduplicated) With at Least One Service 2178
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Center 01
Flag Claims Units Chgs Paid
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R 7 2.000000 47.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 6411 4320.750000 165477.6200 0.0000
P 0 0.000000 0.0000 0.0000
D 2 2.250000 159.2500 0.0000
S 177 157.000000 6130.0000 0.0000
H 28 39.500000 2930.3800 0.0000
T 0 0.000000 0.0000 0.0000
4755 3074.500000 83363.4200 0.0000
Other 94 102.250000 6224.8800 0.0000
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Total 11474 7698.250000 264332.5500 0.0000