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
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 372 212.500000 7862.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 347 2245.000000 9.2500 0.0041
TCM-T1017TL-TARGETED CASE MANAGEMENT 236 614.000000 22588.5000 36.7891
Subtotal (Total Children Is Unduplicated) 609 3071.500000 30460.2500 9.9171
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.000000 1084.2400 60.2356
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 530.0000 66.2500
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 706.0000 50.4286
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 20 52.000000 3023.3900 58.1421
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 60 67.250000 3362.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 132 245.000000 12231.2500 49.9235
CONIP-CONIP-CONSULT, PHONE 5 2.000000 47.0000 23.5000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 57.750000 2797.5000 48.4416
INTR-T1013-INTERPRETER 7 18.000000 900.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 349 1643.000000 16430.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 12.9500 12.9500
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 13.000000 928.7200 71.4400
TRAV-TRAVS-Travel by mile 390 21554.00000 9585.6850 0.4447
Subtotal (Total Children Is Unduplicated) 421 23602.00000 46320.6050 1.9626
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Total 26725.500000 79804.2450 2.9861
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Number of Children (Unduplicated) With at Least One Service 738
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Center 52
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 0 0.000000 0.0000 0.0000
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 2009 20710.250000 41647.5250 38717.8600
2740 6000.250000 37679.5300 99.0800
Other 0 0.000000 0.0000 0.0000
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Total 4758 26725.500000 79804.2450 39294.1300