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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 1448 3670.750000 135135.5000 36.8141
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1316 8211.250000 804.7500 0.0980
TCM-T1017TL-TARGETED CASE MANAGEMENT 447 1713.500000 63038.7500 36.7895
Subtotal (Total Children Is Unduplicated) 1660 13595.50000 198979.0000 14.6357
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 7.000000 339.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 33 50.750000 2537.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 50 56.000000 4200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 45 51.000000 3825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 40.000000 2220.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 19.000000 1425.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 50.500000 2802.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 30 57.000000 4237.5000 74.3421
Subtotal (Total Children Is Unduplicated) 177 338.750000 22149.7500 65.3867
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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 205 283.250000 14131.2500 49.8897
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 6.000000 150.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 591 1704.750000 84493.7500 49.5637
CONIP-CONIP-CONSULT, ITDS PHONE 108 48.250000 1206.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 14.000000 700.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 6 20.000000 1466.4000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 30.000000 750.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 77 346.750000 17337.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 976 10823.00000 108082.0000 9.9863
TRAV-TRAVS-Travel by mile 1 6.000000 2.6700 0.4450
Subtotal (Total Children Is Unduplicated) 976 13283.00000 228340.8000 17.1905
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Total 27217.250000 449469.5500 16.5141
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Number of Children (Unduplicated) With at Least One Service 1661
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Center 53
Flag Claims Units Chgs Paid
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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 4 3.750000 30.0000 55.5800
D 0 0.000000 0.0000 0.0000
S 1 1.250000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 6664 5146.000000 81704.9700 81694.9700
29233 21849.750000 363112.0800 130.5000
Other 228 216.500000 4622.5000 0.0000
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Total 36130 27217.250000 449469.5500 81881.0500