CMS/EIP Fiscal Report Center: 09
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 1594 4274.250000 158128.7500 36.9957
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 832 972.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1519 5208.500000 192705.2500 36.9982
Subtotal (Total Children Is Unduplicated) 1719 10455.00000 350834.0000 33.5566
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 94 180.500000 8950.0000 49.5845
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 37.000000 2681.3700 72.4695
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 5.500000 412.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 15.500000 1162.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 21.500000 1193.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 189 279.500000 20641.2500 73.8506
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 102 136.500000 9658.8900 70.7611
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 66 105.500000 7614.5600 72.1759
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 212 333.500000 18509.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 129 175.000000 13043.0000 74.5314
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 16 85.000000 4250.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 204.2000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 482 1384.500000 88685.3700 64.0559
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 161 250.500000 12525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 32 28.500000 712.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 184 366.750000 18337.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 59 152.000000 3800.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 11.000000 550.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 6.000000 150.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 6.000000 300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 910 6606.500000 329976.2600 49.9472
INTR-T1013-INTERPRETER 115 279.500000 13683.0000 48.9553
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1272 12858.00000 128513.1200 9.9948
OCCT-97530-OT SESSION BY LICENSED OT 151 1126.000000 80408.9000 71.4111
PHY-97110-PT SESSION BY LICENSED PT 214 1785.000000 125641.7300 70.3875
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 445 3807.000000 270123.9500 70.9545
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 104.8800 52.4400
TRAV-TRAVS-Travel by mile 1243 130090.0000 57099.7200 0.4389
Subtotal (Total Children Is Unduplicated) 1421 157386.7500 1042351.5600 6.6229
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Total 169226.250000 1481870.9300 8.7567
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Number of Children (Unduplicated) With at Least One Service 1783
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Center 09
Flag Claims Units Chgs Paid
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R 1 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 92 100.750000 5069.0000 58.5000
P 25712 158393.500000 1124949.4000 1384043.6700
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 0 0.000000 0.0000 0.0000
2304 10729.250000 351750.7800 841.9900
Other 0 0.000000 0.0000 0.0000
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Total 28109 169226.250000 1481870.9300 1384944.1600