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
Agency Filter:EIP DEI DEIP
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
EXIT-EXIT-EXIT ASSESSMENT 2 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 18.000000 1350.0000 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 12 20.500000 1537.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 81 113.500000 8512.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 48 69.000000 5175.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 45 72.500000 5437.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 36 54.500000 3024.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 66 94.000000 7050.0000 75.0000
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-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 236 458.000000 33015.3500 72.0859
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 5.500000 275.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 12.000000 600.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 12.000000 600.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 9.000000 450.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 52 225.000000 11250.0000 50.0000
INTR-T1013-INTERPRETER 137 261.500000 13075.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 2.000000 20.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 13 44.000000 3143.3600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 36 122.000000 8715.6800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 7.000000 400.1200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 105.250000 7267.3800 69.0487
TRAV-TRAVS-Travel by mile 1 2.000000 0.9000 0.4500
Subtotal (Total Children Is Unduplicated) 291 808.250000 45822.4400 56.6934
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Total 9190.750000 340112.0400 37.0059
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Number of Children (Unduplicated) With at Least One Service 2427
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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 0 0.000000 0.0000 0.0000
D 191 252.000000 17339.0500 0.0000
S 947 951.500000 52169.0900 0.0000
H 22 28.500000 2119.7000 0.0000
T 5 5.000000 271.4400 271.4400
5429 3527.000000 104210.0100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13432 9190.750000 340112.0400 271.4400