CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Agency Filter:EXT
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 1 0.250000 9.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18 22.500000 832.5000 37.0000
Subtotal (Total Children Is Unduplicated) 18 22.750000 841.7500 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 25.000000 1875.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 102.1000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 51 51.000000 2603.5500 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 6 6.000000 306.3000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 17 17.000000 867.8500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 82 83.000000 4236.1000 51.0373
Subtotal (Total Children Is Unduplicated) 152 214.000000 11907.5000 55.6425
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 9.000000 450.0000 50.0000
CONIF-CONIF-CONSULT, FACE TO FACE 197 210.500000 10525.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 938.000000 23450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 764 6237.000000 311850.0000 50.0000
INTR-T1013-INTERPRETER 1 3.000000 225.0000 75.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 940 7828.000000 78280.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 127 472.250000 33737.5400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 78 254.500000 14557.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 106 487.000000 34791.2800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 70 316.000000 18062.5600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 225 1175.500000 83977.7200 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 98 392.000000 22422.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 2 6.000000 83.2800 13.8800
TRAV-TRAVS-Travel by mile 40 13553.00000 6031.3000 0.4450
Subtotal (Total Children Is Unduplicated) 1188 31881.75000 638443.4800 20.0254
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Total 32118.500000 651192.7300 20.2747
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Number of Children (Unduplicated) With at Least One Service 1193
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Center 57
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 1 1.000000 37.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 167 560.500000 9053.8300 9063.8300
H 0 0.000000 0.0000 0.0000
T 3496 23690.250000 242430.4300 243541.2400
2617 7759.750000 395809.2000 392082.9500
Other 71 107.000000 3862.2700 3923.7100
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Total 6352 32118.500000 651192.7300 648611.7300