CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2015 ending 06/30/2016 Date of Report:08/06/2016 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 189 240.750000 8833.7500 36.6926
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 239 707.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 246 1318.750000 48655.0000 36.8948
Subtotal (Total Children Is Unduplicated) 251 2267.000000 57488.7500 25.3590
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 13.500000 1012.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 17.000000 888.0000 52.2353
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 55.000000 4087.5000 74.3182
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 20.000000 1500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 11.000000 825.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 167 279.500000 15540.0000 55.5993
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 197 332.500100 25087.5075 75.4511
Subtotal (Total Children Is Unduplicated) 239 741.500100 49915.5075 67.3169
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 4.000000 200.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 8.750000 512.5000 58.5714
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.250000 6.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 60.750000 3037.5000 50.0000
INTR-T1013-INTERPRETER 1 4.000000 280.0000 70.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 233 522.000000 5211.0000 9.9828
TRAV-A0160-*PROV TRAVEL TO NATURAL ENV-BY MIN 10 396.000000 198.0000 0.5000
TRAV-TRAVS-Travel by mile 85 3360.000000 1495.4650 0.4451
Subtotal (Total Children Is Unduplicated) 242 4355.750000 10940.7150 2.5118
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Total 7364.250100 118344.9725 16.0702
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Number of Children (Unduplicated) With at Least One Service 266
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Center 53
Flag Claims Units Chgs Paid
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R 41 34.500000 1276.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 270 305.500000 14927.2500 0.0000
P 855 931.000000 41644.2500 41644.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 220 2223.000000 4589.6750 4589.6750
T 485 2065.000000 7631.5400 7631.5900
1967 1805.250100 48275.7575 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3838 7364.250100 118344.9725 53865.5150