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
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
EXIT-EXIT-EXIT ASSESSMENT 2 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 18.000000 1350.0000 75.0000
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 6 8.500000 471.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 12.000000 900.0000 75.0000
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 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 34 69.000000 4886.3500 70.8167
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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 8 39.000000 1950.0000 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 3 9.000000 642.9600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 5 13.000000 928.7200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 2 5.000000 285.8000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 18.000000 1055.6800 58.6489
TRAV-TRAVS-Travel by mile 1 2.000000 0.9000 0.4500
Subtotal (Total Children Is Unduplicated) 192 389.000000 19909.0600 51.1801
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Total 3664.750000 111555.1600 30.4400
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Number of Children (Unduplicated) With at Least One Service 1695
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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 0 0.000000 0.0000 0.0000
D 40 48.500000 2849.4900 0.0000
S 93 97.750000 4970.7200 0.0000
H 0 0.000000 0.0000 0.0000
T 5 5.000000 271.4400 271.4400
5407 3513.500000 103463.5100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5545 3664.750000 111555.1600 271.4400