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
Payclass Filters:GR
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 1017.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 647 2149.500000 79531.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1808 7615.750000 244107.5000 32.0530
-----------------------------------------------------------------------------------------------------------------------
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 2 3.000000 116.3700 38.7900
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 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 53 82.500000 5784.7900 70.1187
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 34.500000 1847.6400 53.5548
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 35.000000 2225.6200 63.5891
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 87 129.500000 7187.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 98 141.000000 10555.5000 74.8617
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
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 303 653.500000 39226.4200 60.0251
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 137 219.750000 10987.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 23 21.000000 525.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 159 306.250000 15312.5000 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 259 1754.500000 87705.0000 49.9886
INTR-T1013-INTERPRETER 130 295.750000 14495.5000 49.0127
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1272 12856.00000 128493.1200 9.9948
OCCT-97530-OT SESSION BY LICENSED OT 102 775.000000 55333.4600 71.3980
PHY-97110-PT SESSION BY LICENSED PT 138 1004.000000 69917.5300 69.6390
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 352 2603.000000 184328.8500 70.8140
TRAV-TRAVS-Travel by mile 1174 109148.0000 47817.0900 0.4381
Subtotal (Total Children Is Unduplicated) 1395 129132.5000 619196.8000 4.7951
-----------------------------------------------------------------------------------------------------------------------
Total 137401.750000 902530.7200 6.5686
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1917
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 20847 135355.000000 887389.2000 887416.2800
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
251 2046.750000 15141.5200 581.4500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 21098 137401.750000 902530.7200 887997.7300