CMS/EIP Fiscal Report Center: 53
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 675 1025.750000 37446.2500 36.5062
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 629 2169.750000 786.2500 0.3624
TCM-T1017TL-TARGETED CASE MANAGEMENT 802 2515.250000 92250.2500 36.6764
Subtotal (Total Children Is Unduplicated) 919 5710.750000 130482.7500 22.8486
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 13 18.250000 912.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 64.000000 4800.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 39.000000 2925.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 62.500000 3468.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 40.500000 3037.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 22.000000 1650.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 73 126.500000 7020.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 83 160.000000 12000.0000 75.0000
Subtotal (Total Children Is Unduplicated) 189 546.750000 36811.5000 67.3278
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 89 86.750000 4337.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 227 378.500000 18887.5000 49.9009
CONIP-CONIP-CONSULT, PHONE 24 12.000000 300.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 11.000000 806.5200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 15.000000 375.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 294 1715.750000 85775.0000 49.9927
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 494 2603.000000 25972.0000 9.9777
Subtotal (Total Children Is Unduplicated) 503 4826.000000 136553.5200 28.2954
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Total 11083.500000 303847.7700 27.4144
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Number of Children (Unduplicated) With at Least One Service 922
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Center 53
Flag Claims Units Chgs Paid
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R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1696 1575.000000 65186.0000 0.0000
P 1575 1553.000000 73303.0000 73367.7500
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 2867 2236.000000 36051.4600 36051.4600
7340 5597.750000 126731.3100 111.0000
Other 127 121.250000 2557.5000 0.0000
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Total 13606 11083.500000 303847.7700 109530.2100