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
Agency Filter:EXT
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
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1 0.500000 0.0000 0.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 10 19.000000 950.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 12 33.000000 1650.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 27 62.000000 3278.1500 52.8734
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 126 196.500000 9825.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 21 19.500000 487.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 156 302.750000 15137.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 48 114.250000 2856.2500 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 251 1730.000000 86480.0000 49.9884
INTR-T1013-INTERPRETER 1 42.000000 1808.0000 43.0476
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1272 12856.00000 128493.1200 9.9948
OCCT-97530-OT SESSION BY LICENSED OT 99 768.000000 54865.9200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 133 986.000000 68631.6100 69.6061
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 347 2589.000000 183575.3500 70.9059
TRAV-TRAVS-Travel by mile 1174 109148.0000 47817.0900 0.4381
Subtotal (Total Children Is Unduplicated) 1303 128787.0000 601402.3400 4.6697
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Total 128849.500000 604680.4900 4.6929
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Number of Children (Unduplicated) With at Least One Service 1304
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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 9786 126837.500000 591606.6100 591623.6900
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
219 2012.000000 13073.8800 418.5700
Other 0 0.000000 0.0000 0.0000
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Total 10005 128849.500000 604680.4900 592042.2600