CMS/EIP Fiscal Report Center: 09
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 1570 4757.750000 175981.2500 36.9883
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 830 957.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1517 5276.250000 195110.2500 36.9790
Subtotal (Total Children Is Unduplicated) 1709 10991.25000 371091.5000 33.7624
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 96 191.750000 9387.5000 48.9570
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 22.000000 1650.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 196 305.000000 22339.0000 73.2426
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 104 140.000000 10404.3900 74.3171
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 82 120.500000 8928.7500 74.0975
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 186 300.500000 16677.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 133 180.000000 13500.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 13 68.000000 3400.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 8 8.000000 408.4000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 457 1358.750000 88197.3900 64.9107
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 149 277.750000 12202.1900 43.9323
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 18 17.000000 425.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 210 437.500000 21875.0000 50.0000
CONIP-CONIP-CONSULT, PHONE 30 81.500000 2037.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 916 6304.500000 315025.0000 49.9683
INTR-T1013-INTERPRETER 86 192.250000 9436.5000 49.0845
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1291 12288.00000 122880.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 143 1083.000000 77369.5200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 230 1719.000000 117637.4200 68.4336
PHY-97110HM-PT SESSION BY PT ASST 1 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 425 3606.250000 256618.2100 71.1593
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 1259 126356.0000 55252.3100 0.4373
Subtotal (Total Children Is Unduplicated) 1403 152366.7500 990944.0100 6.5037
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Total 164716.750000 1450232.9000 8.8044
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Number of Children (Unduplicated) With at Least One Service 1762
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Center 09
Flag Claims Units Chgs Paid
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R 5 5.000000 198.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 162 185.750000 10037.6900 225.2500
P 25860 155534.250000 1088563.9400 1199563.1900
D 0 0.000000 0.0000 0.0000
S 1 1.250000 46.2500 46.2500
H 0 0.000000 0.0000 0.0000
T 1 1.000000 50.0000 0.0000
2435 8989.500000 351337.0200 866.1100
Other 0 0.000000 0.0000 0.0000
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Total 28464 164716.750000 1450232.9000 1200700.8000