CMS/EIP Fiscal Report Center: 06
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 1365 1516.500000 56110.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 668 544.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 495 1155.000000 42735.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1458 3215.500000 98845.5000 30.7403
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 10 16.750000 837.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 18.500000 1387.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 12.500000 693.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 57.2700 57.2700
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 2.000000 41.0500 20.5250
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 151.0500 50.3500
Subtotal (Total Children Is Unduplicated) 29 70.750000 4413.8700 62.3869
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1481.7500 1481.7500
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 87 87.000000 4037.5000 46.4080
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 32 82.500000 3962.5000 48.0303
CONIP-CONIP-CONSULT, PHONE 19 34.750000 793.7500 22.8417
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 187 1393.250000 69325.0000 49.7578
INTR-T1013-INTERPRETER 27 128.000000 8353.0000 65.2578
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 829 6689.000000 66670.0000 9.9671
OCCT-97530-OT SESSION BY LICENSED OT 28 98.500000 6224.8900 63.1969
OCCT-97530HM-OT SESSION BY OT ASST 3 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 40 175.750000 11631.4900 66.1820
PHY-97110HM-PT SESSION BY PT ASST 9 24.750000 1149.8900 46.4602
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 117 511.500000 35435.0600 69.2768
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 52.8000 13.2000
Subtotal (Total Children Is Unduplicated) 857 9238.000000 209446.4300 22.6723
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Total 12524.250000 312705.8000 24.9680
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Number of Children (Unduplicated) With at Least One Service 1615
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Center 06
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 9246 8739.750000 199685.2300 199685.2300
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
7073 3784.500000 113020.5700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 16319 12524.250000 312705.8000 199685.2300