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
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16 11.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7 13.750000 508.7500 37.0000
Subtotal (Total Children Is Unduplicated) 23 25.500000 508.7500 19.9510
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 11.000000 825.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 5.500000 412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 12.500000 693.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.500000 187.5000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 12 52.000000 2600.0000 50.0000
Subtotal (Total Children Is Unduplicated) 22 87.000000 4981.2500 57.2557
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 30.750000 1537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 7.500000 187.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 60 60.500000 3025.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 25 37.750000 943.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 88 346.000000 17270.0000 49.9133
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 2.000000 20.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 86.000000 6143.8400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 37 141.000000 10073.0400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 146 625.000000 44602.9400 71.3647
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 104.8800 52.4400
TRAV-TRAVS-Travel by mile 418 20942.00000 9282.6300 0.4433
Subtotal (Total Children Is Unduplicated) 466 22280.50000 93191.0800 4.1826
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Total 22393.000000 98681.0800 4.4068
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Number of Children (Unduplicated) With at Least One Service 480
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Center 09
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 1087 19418.000000 77068.9600 77068.9600
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
184 2975.000000 21612.1200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1271 22393.000000 98681.0800 77068.9600