CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 Page: 1
List order: No List
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 693 304.500000 11259.2500 36.9762
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 881 861.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2376 6758.750000 250015.0000 36.9913
Subtotal (Total Children Is Unduplicated) 2416 7924.500000 261274.2500 32.9704
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 16.000000 776.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 103 198.000000 9900.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 29.000000 2175.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 15 26.000000 1940.0000 74.6154
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 12.500000 693.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 129 201.000000 14354.7500 71.4167
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 72.000000 5400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 74.500000 5587.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 134 209.500000 11599.5000 55.3675
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 81 123.500000 9154.0000 74.1215
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 204.2000 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 12.000000 567.5500 47.2958
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 424 989.500000 63047.1000 63.7161
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 132 161.500000 8062.5000 49.9226
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 74 151.000000 7550.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.500000 62.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 7 8.000000 400.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 17 21.000000 1050.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 37 54.750000 2737.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 350 1996.250000 98845.5900 49.5156
INTR-T1013-INTERPRETER 171 445.500000 22175.0000 49.7755
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1197 8996.000000 89345.2100 9.9317
OCCT-97530-OT SESSION BY LICENSED OT 36 211.750000 14790.1100 69.8470
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 77 349.500000 22221.3900 63.5805
PHY-97110HM-PT SESSION BY PT ASST 5 11.000000 628.7600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 135 733.500000 50848.1100 69.3226
SPL-92508-GROUP SPL SESSION PER CHILD 3 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 742 65688.00000 27674.8100 0.4213
Subtotal (Total Children Is Unduplicated) 1426 78839.75000 346713.3000 4.3977
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Total 87753.750000 671034.6500 7.6468
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Number of Children (Unduplicated) With at Least One Service 2526
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Center 01
Flag Claims Units Chgs Paid
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R 44 20.750000 767.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 6794 4406.000000 163235.0000 0.0000
P 15979 71022.750000 291105.7600 291105.7600
D 866 3384.250000 41969.6600 10.0000
S 983 1006.500000 55959.0900 112.5000
H 22 28.500000 2119.7000 0.0000
T 675 3686.500000 10029.2900 10029.2600
5534 4198.500000 105848.4000 50.0000
Other 0 0.000000 0.0000 0.0000
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Total 30897 87753.750000 671034.6500 301307.5200