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:EIP DEI DEIP
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 832 971.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1519 5208.500000 192705.2500 36.9982
Subtotal (Total Children Is Unduplicated) 1719 10454.50000 350834.0000 33.5582
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 84 161.500000 8000.0000 49.5356
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 187 276.000000 20378.7500 73.8361
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 64 102.000000 7352.0600 72.0790
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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 456 1269.500000 82756.1700 65.1880
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 15 23.250000 1162.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 15 11.000000 550.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 47 234.500000 11725.0000 50.0000
INTR-T1013-INTERPRETER 114 237.500000 11875.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 68.000000 4825.3800 70.9615
PHY-97110-PT SESSION BY LICENSED PT 20 98.000000 7001.1200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 117.000000 7940.2200 67.8651
Subtotal (Total Children Is Unduplicated) 210 790.750000 45116.7200 57.0556
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Total 12514.750000 478706.8900 38.2514
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Number of Children (Unduplicated) With at Least One Service 1737
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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 14945 12238.500000 461977.9700 721055.1600
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
145 172.750000 11558.1700 423.4200
Other 0 0.000000 0.0000 0.0000
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Total 15183 12514.750000 478706.8900 721537.0800