CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2016 ending 06/30/2016 Date of Report:08/06/2016 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 760 1086.000000 40117.2500 36.9404
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 735 2625.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 916 2849.000000 104913.5000 36.8247
Subtotal (Total Children Is Unduplicated) 1047 6560.500000 145030.7500 22.1067
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 10 16.500000 825.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 50.000000 3750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 18 46.500000 3487.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 35.500000 1970.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 23.000000 1725.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 25.000000 1875.0000 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 103 172.000000 9546.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 94 167.000000 12525.0000 75.0000
Subtotal (Total Children Is Unduplicated) 198 547.000000 36566.2500 66.8487
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 79 92.500000 4600.0000 49.7297
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 313 681.500000 34012.5000 49.9083
CONIP-CONIP-CONSULT, ITDS PHONE 20 11.000000 275.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 14.000000 700.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 14 37.000000 2712.8400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 51.000000 1275.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 333 1910.000000 95500.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 558 3839.000000 38390.0000 10.0000
TRAV-TRAVS-Travel by mile 1 6.000000 2.6700 0.4450
Subtotal (Total Children Is Unduplicated) 558 6642.250000 177474.2600 26.7190
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Total 13749.750000 359071.2600 26.1147
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Number of Children (Unduplicated) With at Least One Service 1048
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Center 53
Flag Claims Units Chgs Paid
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R 157 140.500000 5158.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1471 1459.000000 69302.5000 0.0000
P 2003 1760.500000 73890.5000 73843.5000
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 3784 2907.500000 45536.0300 45476.0300
9496 7480.250000 165083.4800 130.5000
Other 2 2.000000 100.0000 0.0000
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Total 16913 13749.750000 359071.2600 119450.0300