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
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 1 0.500000 18.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.500000 18.5000 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 17 30.750000 1537.5000 50.0000
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) 30 67.750000 3391.7000 50.0620
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 123 229.500000 9789.6900 42.6566
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 11.000000 275.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 173 343.250000 17162.5000 50.0000
CONIP-CONIP-CONSULT, PHONE 28 59.250000 1481.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 248 1541.500000 76875.0000 49.8703
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 97 771.000000 55080.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 122 884.000000 58108.2000 65.7333
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 333 2536.000000 180313.5500 71.1016
TRAV-TRAVS-Travel by mile 1156 98060.00000 42860.3000 0.4371
Subtotal (Total Children Is Unduplicated) 1314 116751.5000 566149.7300 4.8492
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Total 116819.750000 569559.9300 4.8755
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Number of Children (Unduplicated) With at Least One Service 1314
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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 9446 116087.750000 558348.4100 558348.4100
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
171 732.000000 11211.5200 632.8900
Other 0 0.000000 0.0000 0.0000
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Total 9617 116819.750000 569559.9300 558981.3000