CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 72 71.000000 2590.0000 36.4789
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 87 183.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 92 405.250000 14975.7500 36.9543
Subtotal (Total Children Is Unduplicated) 93 660.000000 17565.7500 26.6148
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 138.7500 39.6429
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 13.500000 975.0000 72.2222
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 54 88.500000 4911.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 98.500000 7312.5000 74.2386
Subtotal (Total Children Is Unduplicated) 71 216.500000 14275.5000 65.9376
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.500000 75.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 7.000000 350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 74 144.000000 1440.0000 10.0000
TRAV-TRAVS-Travel by mile 28 681.000000 303.1300 0.4451
Subtotal (Total Children Is Unduplicated) 74 834.500000 2218.1300 2.6580
-----------------------------------------------------------------------------------------------------------------------
Total 1711.000000 34059.3800 19.9061
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 93
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 25 21.250000 786.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 199 210.500000 9064.2500 111.0000
P 166 202.500000 9905.0000 9905.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 35 206.000000 482.4600 482.4600
T 31 327.500000 410.5000 410.5000
669 743.250000 13410.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1125 1711.000000 34059.3800 10908.9600