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: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
Subtotal (Total Children Is Unduplicated) 10 35.000000 2381.2500 68.0357
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 7.500000 375.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 13.000000 650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 8.000000 571.5200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 4 10.000000 714.4000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 13.000000 928.7200 71.4400
Subtotal (Total Children Is Unduplicated) 21 51.500000 3239.6400 62.9056
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Total 112.000000 6129.6400 54.7289
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Number of Children (Unduplicated) With at Least One Service 38
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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 106 100.500000 5704.1400 5704.1400
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
8 11.500000 425.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 114 112.000000 6129.6400 5704.1400