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
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 693 304.500000 11259.2500 36.9762
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 881 861.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 750 2041.000000 75500.5000 36.9919
Subtotal (Total Children Is Unduplicated) 1639 3206.750000 86759.7500 27.0554
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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 5 9.000000 675.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 402.5000 73.1818
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 77.500000 5092.2500 65.7065
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 12.500000 937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 71 115.000000 6354.7500 55.2587
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 23.000000 1616.5000 70.2826
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 102.1000 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 516.5000 46.9545
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 228 486.500000 27493.8000 56.5135
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 130 159.500000 7962.5000 49.9216
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 297 1760.500000 87058.0900 49.4508
INTR-T1013-INTERPRETER 171 445.500000 22175.0000 49.7755
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1197 8995.000000 89335.2100 9.9317
OCCT-97530-OT SESSION BY LICENSED OT 26 176.750000 12289.7100 69.5316
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 43 225.500000 13383.2200 59.3491
PHY-97110HM-PT SESSION BY PT ASST 3 7.000000 400.1200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 101 604.250000 41673.9300 68.9680
SPL-92508-GROUP SPL SESSION PER CHILD 3 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 741 65655.00000 27660.1200 0.4213
Subtotal (Total Children Is Unduplicated) 1370 78275.75000 314059.7200 4.0122
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Total 81969.000000 428313.2700 5.2253
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Number of Children (Unduplicated) With at Least One Service 2146
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Center 01
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 15937 70980.000000 288647.2900 288647.2900
D 602 3050.250000 19608.3300 10.0000
S 102 110.250000 5573.2200 112.5000
H 0 0.000000 0.0000 0.0000
T 669 3647.500000 9633.7800 9633.7500
5508 4181.000000 104850.6500 50.0000
Other 0 0.000000 0.0000 0.0000
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Total 22818 81969.000000 428313.2700 298453.5400