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
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 675 1025.750000 37446.2500 36.5062
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 628 2166.500000 786.2500 0.3629
TCM-T1017TL-TARGETED CASE MANAGEMENT 159 369.000000 13579.0000 36.7995
Subtotal (Total Children Is Unduplicated) 837 3561.250000 51811.5000 14.5487
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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 12 17.250000 862.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 17.000000 1275.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 9.000000 675.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 17.000000 943.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 22.500000 1687.5000 75.0000
Subtotal (Total Children Is Unduplicated) 51 102.250000 6628.7500 64.8289
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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 3 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 35 123.250000 6162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 493 2594.000000 25882.0000 9.9776
Subtotal (Total Children Is Unduplicated) 499 3218.500000 56701.0200 17.6172
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Total 6882.000000 115141.2700 16.7308
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Number of Children (Unduplicated) With at Least One Service 844
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Center 53
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2867 2236.000000 36051.4600 36051.4600
6234 4524.750000 76532.3100 0.0000
Other 127 121.250000 2557.5000 0.0000
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Total 9228 6882.000000 115141.2700 36051.4600