CMS/EIP Fiscal Report Center: 05
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 285 154.000000 5698.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 240 222.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 716 2066.750000 76469.7500 37.0000
Subtotal (Total Children Is Unduplicated) 718 2442.750000 82167.7500 33.6374
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 47 69.500000 3475.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 79.000000 5925.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 31 37.000000 2775.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 16.000000 888.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 60 89.500000 6712.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 6.000000 306.3000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 329.1800 41.1475
Subtotal (Total Children Is Unduplicated) 140 317.500000 21178.2800 66.7032
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 83 91.000000 4550.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.250000 56.2500 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 101 130.250000 6512.5000 50.0000
CONIP-CONIP-CONSULT, PHONE 7 5.750000 143.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 49.250000 1231.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 184 1075.000000 53750.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 159 562.000000 5620.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 68.250000 4203.5700 61.5908
PHY-97110-PT SESSION BY LICENSED PT 25 79.500000 3418.4000 42.9987
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 62 263.000000 17697.4800 67.2908
TRAV-TRAVS-Travel by mile 463 48873.00000 21751.3950 0.4451
Subtotal (Total Children Is Unduplicated) 490 51199.25000 118934.5950 2.3230
-----------------------------------------------------------------------------------------------------------------------
Total 53959.500000 222280.6250 4.1194
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 732
-----------------------------------------------------------------------------------------------------------------------
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2389 1488.000000 61002.0000 0.0000
P 3062 50759.750000 121598.6450 102730.7500
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 0 0.000000 0.0000 0.0000
2376 1711.750000 39679.9800 37.7400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7827 53959.500000 222280.6250 102768.4900