CMS/EIP Fiscal Report Center: 52
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 372 212.500000 7862.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 347 2245.750000 34.2500 0.0153
TCM-T1017TL-TARGETED CASE MANAGEMENT 715 1818.250000 66951.5000 36.8219
Subtotal (Total Children Is Unduplicated) 769 4276.500000 74848.2500 17.5022
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 82 171.500000 12182.5000 71.0350
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 69 140.000000 10330.0000 73.7857
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 48.000000 3600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 161 318.500000 17501.2300 54.9489
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 10.000000 510.5000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 27 27.000000 1350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 209 739.000000 46889.9800 63.4506
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 62 69.500000 3475.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 133 248.000000 12381.2500 49.9244
CONIP-CONIP-CONSULT, PHONE 5 2.000000 47.0000 23.5000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 179 846.250000 42140.0000 49.7962
INTR-T1013-INTERPRETER 7 18.000000 900.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 349 1643.000000 16430.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 80.000000 5715.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 13 41.500000 2893.3200 69.7186
PHY-97110HM-PT SESSION BY PT ASST 6 22.500000 1286.1000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 275.250000 19293.4300 70.0942
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 390 21554.00000 9585.6850 0.4447
Subtotal (Total Children Is Unduplicated) 422 24805.00000 114227.5050 4.6050
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Total 29820.500000 235965.7350 7.9129
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Number of Children (Unduplicated) With at Least One Service 823
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Center 52
Flag Claims Units Chgs Paid
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R 22 40.500000 3018.5000 830.0000
U 0 0.000000 0.0000 0.0000
B 1647 1580.000000 78091.7500 13382.5000
P 802 667.500000 24462.7400 24460.2400
D 0 0.000000 0.0000 0.0000
S 9 15.000000 477.1900 477.1900
H 0 0.000000 0.0000 0.0000
T 2246 20951.250000 57648.4250 48830.3600
3254 6566.250000 72267.1300 99.0800
Other 0 0.000000 0.0000 0.0000
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Total 7980 29820.500000 235965.7350 88079.3700