CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
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 676 578.750000 21413.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1448 5802.250000 214683.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1494 6381.000000 236097.0000 37.0000
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 69 73.500000 3675.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 71 75.000000 3750.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 9.500000 712.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 21 16.500000 1237.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 27 31.500000 2362.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 44 52.000000 2886.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 62 38.500000 2887.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 26.000000 1950.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 108 72.000000 5400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 314 387.000000 21478.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 167 144.000000 10800.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 59 59.000000 3707.0000 62.8305
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 57.2700 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 12 12.000000 436.5400 36.3783
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 5.000000 255.2500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 22 22.000000 1123.1000 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 8 8.000000 408.4000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 16 16.000000 816.8000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 19 19.000000 969.9500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 12 13.000000 663.6500 51.0500
Subtotal (Total Children Is Unduplicated) 548 1083.500000 65802.4600 60.7314
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 32 50.500000 2525.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 3.000000 150.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 64 5371.000000 134275.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1076 9633.500000 480842.0000 49.9135
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1050 9334.000000 93340.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 46 285.750000 20293.9800 71.0201
OCCT-97530HM-OT SESSION BY OT ASST 5 29.500000 1687.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 49 203.500000 14538.0400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 19 111.000000 6344.7600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 60 262.000000 18669.0400 71.2559
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 23.000000 1315.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 6 3.000000 41.6400 13.8800
Subtotal (Total Children Is Unduplicated) 1217 25309.75000 774022.4600 30.5820
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Total 32774.250000 1075921.9200 32.8283
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Number of Children (Unduplicated) With at Least One Service 1688
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Center 04
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 152 203.500000 8517.5000 0.0000
P 6178 15385.750000 355101.6300 355610.1800
D 45 62.500000 2312.5000 0.0000
S 2 4.250000 157.2500 0.0000
H 2350 8160.000000 409433.6800 281.4400
T 0 0.000000 0.0000 0.0000
3550 8834.250000 292525.2700 0.0000
Other 56 124.000000 7874.0900 1055.1400
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Total 12333 32774.250000 1075921.9200 356946.7600