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
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 285 154.000000 5698.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 240 222.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 266 758.000000 28046.0000 37.0000
Subtotal (Total Children Is Unduplicated) 501 1134.000000 33744.0000 29.7566
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 47 69.500000 3475.0000 50.0000
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 12 21.000000 1575.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 12.000000 900.0000 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 10 16.000000 1200.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 329.1800 41.1475
Subtotal (Total Children Is Unduplicated) 86 152.000000 8885.5300 58.4574
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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 176 1038.000000 51900.0000 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) 486 51162.25000 117084.5950 2.2885
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Total 52448.250000 159714.1250 3.0452
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Number of Children (Unduplicated) With at Least One Service 652
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Center 05
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 3061 50757.750000 121498.6450 102630.7500
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
2360 1690.500000 38215.4800 37.7400
Other 0 0.000000 0.0000 0.0000
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Total 5421 52448.250000 159714.1250 102668.4900