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:EIP DEI DEIP
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 4757.250000 175962.7500 36.9883
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 830 957.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1517 5275.500000 195082.5000 36.9790
Subtotal (Total Children Is Unduplicated) 1709 10990.00000 371045.2500 33.7621
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 79 161.000000 7850.0000 48.7578
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 185 289.500000 21176.5000 73.1485
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 70 102.500000 7578.7500 73.9390
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 416 1217.500000 80287.9400 65.9449
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 23.250000 1162.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 15 13.000000 650.0000 50.0000
CONIP-CONIP-CONSULT, PHONE 1 0.250000 6.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 38 196.000000 9800.0000 50.0000
INTR-T1013-INTERPRETER 83 164.250000 8112.5000 49.3912
OCCT-97530-OT SESSION BY LICENSED OT 12 49.000000 3500.5600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 24 125.000000 8806.8200 70.4546
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 128.250000 9008.1800 70.2392
Subtotal (Total Children Is Unduplicated) 168 700.500000 41084.3100 58.6500
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Total 12908.000000 492417.5000 38.1482
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Number of Children (Unduplicated) With at Least One Service 1718
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Center 09
Flag Claims Units Chgs Paid
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R 3 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 162 185.750000 10037.6900 225.2500
P 15221 12436.000000 464452.0900 575451.3400
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 0 0.000000 0.0000 0.0000
254 281.750000 17761.2200 233.2200
Other 0 0.000000 0.0000 0.0000
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Total 15641 12908.000000 492417.5000 575956.0600