CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2016 ending 09/30/2016 Date of Report:10/31/2016 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 12.500000 937.5000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 32 109.000000 5450.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 46 128.500000 6792.7500 52.8619
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 52 60.000000 3000.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 7.500000 187.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 78 119.750000 5987.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 31 65.750000 1643.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 6.000000 300.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 29 43.000000 2150.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 12.000000 300.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 29 30.000000 1500.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 13 32.000000 800.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 230.000000 5750.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 13.000000 650.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 170 804.500000 40225.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 19 30.000000 300.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 73 337.250000 23959.0000 71.0423
OCCT-97530HM-OT SESSION BY OT ASST 7 44.000000 2516.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 98 493.000000 35058.8400 71.1133
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 260 1541.500000 109633.1300 71.1211
TRAV-TRAVS-Travel by mile 862 58549.00000 25884.6000 0.4421
Subtotal (Total Children Is Unduplicated) 956 62418.25000 259846.1200 4.1630
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Total 62546.750000 266638.8700 4.2630
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Number of Children (Unduplicated) With at Least One Service 966
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Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 1606 29651.500000 123852.7400 123852.7400
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 1545 32358.500000 119903.9200 119903.9200
36 89.000000 4950.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3187 62099.000000 248706.9000 243756.6600
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
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 0 0.000000 0.0000 0.0000
16 39.250000 2057.3600 1257.8200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16 39.250000 2057.3600 1257.8200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
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 0 0.000000 0.0000 0.0000
126 119.500000 7988.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 126 119.500000 7988.6000 0.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
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 1 1.000000 10.0000 10.0000
21 230.000000 5750.0000 5750.0000
Other 38 58.000000 2126.0100 2126.0100
---------------------------------------------------------
Total 60 289.000000 7886.0100 7886.0100