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
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 1570 4757.750000 175981.2500 36.9883
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 823 908.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 548 1865.250000 68977.2500 36.9802
Subtotal (Total Children Is Unduplicated) 1638 7531.500000 244958.5000 32.5245
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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 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 70.000000 4911.5000 70.1643
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 30.000000 2154.3900 71.8130
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 21.000000 1466.2500 69.8214
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 56 92.000000 5106.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 50 70.000000 5250.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 9 33.000000 1650.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 153.1500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 219 515.750000 30429.8400 59.0011
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 135 251.750000 10902.1900 43.3056
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 12.500000 312.5000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 176 349.250000 17462.5000 50.0000
CONIP-CONIP-CONSULT, PHONE 29 59.500000 1487.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 251 1551.500000 77375.0000 49.8711
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 99 775.000000 55366.0000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 127 901.000000 59240.5600 65.7498
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 342 2565.000000 182231.3100 71.0453
TRAV-TRAVS-Travel by mile 1156 98060.00000 42860.3000 0.4371
Subtotal (Total Children Is Unduplicated) 1369 117005.7500 579554.3600 4.9532
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Total 125053.000000 854942.7000 6.8366
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Number of Children (Unduplicated) With at Least One Service 1731
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Center 09
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 19937 124205.250000 837946.5400 837946.0400
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
279 847.750000 16996.1600 662.8900
Other 0 0.000000 0.0000 0.0000
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Total 20216 125053.000000 854942.7000 838608.9300