CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 112 45.750000 1692.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 10 9.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 217 468.000000 17316.0000 37.0000
Subtotal (Total Children Is Unduplicated) 224 523.000000 19008.7500 36.3456
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 52 92.000000 11500.0000 125.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 62 97.000000 7236.0000 74.5979
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 43.000000 3225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 47.500000 3562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 58.500000 3246.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 17.500000 1312.5000 75.0000
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 138 359.500000 30358.8000 84.4473
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Total 882.500000 49367.5500 55.9406
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Number of Children (Unduplicated) With at Least One Service 233
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Center 03
Flag Claims Units Chgs Paid
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R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 41 53.750000 3745.0000 37.0000
P 316 280.750000 12132.7500 12057.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 45 45.000000 9000.0000 0.0000
T 0 0.000000 0.0000 0.0000
626 502.250000 24462.0500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1029 882.500000 49367.5500 12094.2500