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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 788 397.500000 14707.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 403 1170.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1368 2524.500000 93406.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1513 4092.500000 108114.0000 26.4176
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 10.000000 485.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 112 198.000000 24300.0000 122.7273
EXIT-EXIT-EXIT ASSESSMENT 28 39.750000 1987.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 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 135 225.000000 16836.0000 74.8267
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 54 84.500000 6337.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 70 107.000000 8025.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 89 136.500000 7514.7500 55.0531
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 35.000000 2625.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 102.1000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 11 11.000000 859.4500 78.1318
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 335 859.250000 69764.0000 81.1917
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.000000 245.8200 81.9400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 138 135.750000 6787.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 4.250000 106.2500 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 330 915.000000 45750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 177 570.500000 28525.0000 50.0000
INTR-T1013-INTERPRETER 10 72.000000 2981.3200 41.4072
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 498 2500.000000 24831.0000 9.9324
OCCT-97530-OT SESSION BY LICENSED OT 35 142.000000 11690.1300 82.3249
PHY-97110-PT SESSION BY LICENSED PT 48 194.250000 21416.8400 110.2540
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 71 316.000000 32555.9700 103.0252
TRAV-TRAVS-Travel by mile 434 33664.00000 14985.1400 0.4451
Subtotal (Total Children Is Unduplicated) 635 38516.75000 189874.9700 4.9297
-----------------------------------------------------------------------------------------------------------------------
Total 43468.500000 367752.9700 8.4602
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1600
-----------------------------------------------------------------------------------------------------------------------
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 12.500000 475.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 181 197.750000 12338.3300 111.0000
P 2692 1675.500000 67714.5000 67795.2420
D 24 19.500000 914.4400 0.0000
S 0 0.000000 0.0000 0.0000
H 338 334.500000 55643.9700 0.0000
T 0 0.000000 0.0000 0.0000
11387 41228.750000 230666.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14653 43468.500000 367752.9700 67906.2420