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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1723 4448.500000 164576.0000 36.9958
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 915 1030.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1672 5657.250000 209309.0000 36.9984
Subtotal (Total Children Is Unduplicated) 1883 11135.75000 373885.0000 33.5752
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 94 180.500000 8950.0000 49.5845
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 40.500000 2928.8700 72.3178
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 7.000000 525.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 19.000000 1425.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 25.500000 1415.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 263 386.500000 28434.7900 73.5700
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 147 191.500000 13597.6400 71.0060
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 101 154.500000 11144.5600 72.1331
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 299 458.500000 25419.0000 55.4395
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 197 264.500000 19718.0000 74.5482
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 16 85.000000 4250.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 204.2000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 643 1825.000000 118564.4100 64.9668
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 161 250.500000 12525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 32 28.500000 712.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 184 366.750000 18337.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 59 152.000000 3800.0000 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 910 6606.500000 329976.2600 49.9472
INTR-T1013-INTERPRETER 130 295.750000 14495.5000 49.0127
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1272 12858.00000 128513.1200 9.9948
OCCT-97530-OT SESSION BY LICENSED OT 151 1126.000000 80408.9000 71.4111
PHY-97110-PT SESSION BY LICENSED PT 214 1785.000000 125641.7300 70.3875
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 445 3807.000000 270123.9500 70.9545
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 104.8800 52.4400
TRAV-TRAVS-Travel by mile 1243 130090.0000 57099.7200 0.4389
Subtotal (Total Children Is Unduplicated) 1436 157403.0000 1043164.0600 6.6273
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Total 170363.750000 1535613.4700 9.0137
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Number of Children (Unduplicated) With at Least One Service 1958
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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 98 109.750000 5588.0000 58.5000
P 26619 159481.750000 1175317.6900 1434409.4600
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
2333 10769.500000 354606.0300 881.9900
Other 0 0.000000 0.0000 0.0000
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Total 29051 170363.750000 1535613.4700 1435349.9500