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
Agency Filter:EIP DEI DEIP
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 742 1112.500000 41070.0000 36.9169
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 723 2474.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 858 2820.750000 103674.0000 36.7541
Subtotal (Total Children Is Unduplicated) 956 6407.750000 144744.0000 22.5889
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 5.000000 242.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 7 11.000000 550.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 58.000000 4350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 30 84.000000 6300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 15.000000 1125.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 30 71.000000 3940.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 36.500000 2737.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 22.500000 1687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 117 202.000000 11211.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 117 212.500000 15900.0000 74.8235
Subtotal (Total Children Is Unduplicated) 243 720.500000 48269.0000 66.9938
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 20.9800 20.9800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 92 90.250000 4512.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 272 438.750000 21925.0000 49.9715
CONIP-CONIP-CONSULT, ITDS PHONE 26 9.250000 231.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.000000 73.3200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 14 27.000000 675.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 297 1722.250000 86537.5000 50.2468
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 545 3046.000000 30450.0000 9.9967
Subtotal (Total Children Is Unduplicated) 549 5335.750000 144431.8000 27.0687
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Total 12464.000000 337444.8000 27.0736
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Number of Children (Unduplicated) With at Least One Service 957
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Center 53
Flag Claims Units Chgs Paid
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R 127 93.000000 3587.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2041 1856.750000 80312.5000 0.0000
P 1885 1797.500000 83583.0000 83527.5000
D 0 0.000000 0.0000 0.0000
S 6 10.000000 551.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 20.9800 20.9800
11276 8610.500000 167323.8200 0.0000
Other 101 95.250000 2065.0000 0.0000
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Total 15437 12464.000000 337444.8000 83548.4800