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
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 675 351.500000 13005.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 392 1157.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1149 2053.500000 75979.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1287 3562.250000 88985.0000 24.9800
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 9.000000 436.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 60 106.000000 12800.0000 120.7547
EXIT-EXIT-EXIT ASSESSMENT 28 39.750000 1987.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 72 126.000000 9450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 41.500000 3112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 59.500000 4462.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 48 78.000000 4268.0000 54.7179
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 15.500000 1162.5000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.000000 757.3500 84.1500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 192 488.750000 38750.4000 79.2847
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 33 33.750000 1687.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 166 416.500000 20825.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 62 207.500000 10375.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 25.500000 3557.2800 139.5012
PHY-97110-PT SESSION BY LICENSED PT 30 119.000000 16447.1000 138.2109
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 129.000000 19796.9600 153.4648
Subtotal (Total Children Is Unduplicated) 220 931.750000 72701.3400 78.0267
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Total 4982.750000 200436.7400 40.2261
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Number of Children (Unduplicated) With at Least One Service 1301
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Center 03
Flag Claims Units Chgs Paid
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R 30 11.750000 447.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 140 144.000000 8593.3300 74.0000
P 2372 1391.750000 55470.7500 55626.9920
D 24 19.500000 914.4400 0.0000
S 0 0.000000 0.0000 0.0000
H 293 289.500000 46643.9700 0.0000
T 0 0.000000 0.0000 0.0000
4728 3126.250000 88366.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7587 4982.750000 200436.7400 55700.9920