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
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 4757.250000 175962.7500 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 7531.000000 244940.0000 32.5242
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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 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
Subtotal (Total Children Is Unduplicated) 191 448.000000 27038.1400 60.3530
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 22.250000 1112.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 6 6.000000 300.0000 50.0000
CONIP-CONIP-CONSULT, PHONE 1 0.250000 6.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 10.000000 500.0000 50.0000
INTR-T1013-INTERPRETER 83 164.250000 8112.5000 49.3912
OCCT-97530-OT SESSION BY LICENSED OT 2 4.000000 285.7600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 5 17.000000 1132.3600 66.6094
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 29.000000 1917.7600 66.1297
Subtotal (Total Children Is Unduplicated) 114 254.250000 13404.6300 52.7222
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Total 8233.250000 285382.7700 34.6622
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Number of Children (Unduplicated) With at Least One Service 1650
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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 10491 8117.500000 279598.1300 279597.6300
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
108 115.750000 5784.6400 30.0000
Other 0 0.000000 0.0000 0.0000
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Total 10599 8233.250000 285382.7700 279627.6300