CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 948 2738.750000 101065.5000 36.9021
Subtotal (Total Children Is Unduplicated) 948 2738.750000 101065.5000 36.9021
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 99 187.000000 10378.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 79 177.500000 13312.5000 75.0000
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 138 394.500000 25604.1000 64.9027
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EI Services,Class #03
AUD-92633-AUD REHAB POSTLING HEARING LOSS 1 2.000000 143.2200 71.6100
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 27 71.500000 3575.0000 50.0000
Subtotal (Total Children Is Unduplicated) 28 73.500000 3718.2200 50.5880
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Total 3206.750000 130387.8200 40.6604
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Number of Children (Unduplicated) With at Least One Service 960
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Center 07
Flag Claims Units Chgs Paid
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R 28 18.000000 666.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 70 45.750000 1772.5000 0.0000
P 4189 3087.500000 125200.5000 125069.5000
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
30 55.500000 2748.8200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4317 3206.750000 130387.8200 125069.5000