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
Agency Filter:EXT
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 1 0.500000 18.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.750000 27.7500 37.0000
Subtotal (Total Children Is Unduplicated) 2 1.250000 46.2500 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 17 30.750000 1537.5000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 15.500000 1162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 18.000000 1350.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 13 68.000000 3400.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.000000 357.3500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 51 141.250000 7909.4500 55.9961
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 137 254.500000 11039.6900 43.3780
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 15 15.500000 387.5000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 205 424.500000 21225.0000 50.0000
CONIP-CONIP-CONSULT, PHONE 29 81.250000 2031.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 885 6108.500000 305225.0000 49.9673
INTR-T1013-INTERPRETER 3 28.000000 1324.0000 47.2857
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1291 12288.00000 122880.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 131 1034.000000 73868.9600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 206 1594.000000 108830.6000 68.2752
PHY-97110HM-PT SESSION BY PT ASST 1 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 406 3478.000000 247610.0300 71.1932
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) 1318 151666.2500 949859.7000 6.2628
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Total 151808.750000 957815.4000 6.3094
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Number of Children (Unduplicated) With at Least One Service 1320
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Center 09
Flag Claims Units Chgs Paid
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R 2 1.750000 77.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 10639 143098.250000 624111.8500 624111.8500
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 1 1.000000 50.0000 0.0000
2181 8707.750000 333575.8000 632.8900
Other 0 0.000000 0.0000 0.0000
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Total 12823 151808.750000 957815.4000 624744.7400