CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
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 529 560.000000 20720.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 272 342.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 533 975.250000 36075.0000 36.9905
Subtotal (Total Children Is Unduplicated) 642 1878.000000 56795.0000 30.2423
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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 38 60.250000 3012.5000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 90.500000 6712.5000 74.1713
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 26.000000 1825.0000 70.1923
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 64 121.000000 6715.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 22.500000 1687.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 153.1500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 7 7.000000 350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 120 340.250000 21059.9000 61.8954
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 9.000000 11558.3500 1284.2611
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 24 36.750000 1725.0000 46.9388
CONIF-CONIF-CONSULT, FACE TO FACE 43 55.000000 2675.0000 48.6364
CONIP-CONIP-CONSULT, PHONE 1 5.750000 143.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 12.000000 300.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 110 526.750000 26337.5000 50.0000
INTR-T1013-INTERPRETER 10 43.500000 2160.0000 49.6552
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 352 2419.000000 23600.0000 9.7561
OCCT-97530-OT SESSION BY LICENSED OT 19 102.750000 7282.4100 70.8750
PHY-97110-PT SESSION BY LICENSED PT 12 94.000000 3663.1900 38.9701
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 94 724.750000 50848.1800 70.1596
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 215 16513.00000 7101.8300 0.4301
Subtotal (Total Children Is Unduplicated) 478 20543.25000 137409.0900 6.6888
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Total 22761.500000 215263.9900 9.4574
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Number of Children (Unduplicated) With at Least One Service 742
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Center 02
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 0 0.000000 0.0000 0.0000
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 1110 4266.500000 35368.0500 5154.4250
2690 10670.250000 97133.6300 30.0000
Other 3783 7824.750000 82762.3100 0.0000
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Total 7583 22761.500000 215263.9900 5184.4250