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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 675 351.500000 13005.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 392 1156.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 446 804.000000 29748.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1060 2312.000000 42753.5000 18.4920
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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 32 56.000000 2800.0000 50.0000
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 39 66.000000 4950.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 25.500000 1912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 32.000000 2400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 48.000000 2603.0000 54.2292
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 125 283.250000 17590.5500 62.1026
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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 17 50.250000 2512.5000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 5 10.500000 750.1200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 20.500000 1464.5200 71.4400
Subtotal (Total Children Is Unduplicated) 189 532.000000 27252.1400 51.2258
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Total 3127.250000 87596.1900 28.0106
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Number of Children (Unduplicated) With at Least One Service 1087
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Center 03
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 24 19.500000 914.4400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4698 3107.750000 86681.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4722 3127.250000 87596.1900 0.0000