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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 1594 4274.250000 158128.7500 36.9957
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 832 959.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 579 1942.750000 71881.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1652 7176.500000 230010.5000 32.0505
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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 1 2.000000 56.3700 28.1850
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 48.500000 3421.2500 70.5412
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 23.500000 1208.8900 51.4421
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 17.500000 1058.1200 60.4640
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 54 81.000000 4495.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 66 96.500000 7218.0000 74.7979
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 211 439.500000 26026.7300 59.2190
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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 6 3.500000 175.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 24.500000 1225.0000 50.0000
INTR-T1013-INTERPRETER 114 237.500000 11875.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 7.000000 467.5400 66.7914
PHY-97110-PT SESSION BY LICENSED PT 5 18.000000 1285.9200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 14.000000 753.5000 53.8214
Subtotal (Total Children Is Unduplicated) 149 329.250000 16981.9600 51.5777
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Total 7945.250000 273019.1900 34.3626
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Number of Children (Unduplicated) With at Least One Service 1671
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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 10493 7916.500000 271361.5500 271374.0500
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
28 28.750000 1657.6400 122.8800
Other 0 0.000000 0.0000 0.0000
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Total 10521 7945.250000 273019.1900 271496.9300