CMS/EIP Fiscal Report Center: 06
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 1334 1056.250000 39081.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 734 612.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1593 4302.500000 159008.2500 36.9572
Subtotal (Total Children Is Unduplicated) 1704 5971.250000 198089.5000 33.1739
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 4 6.500000 325.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 14.500000 1087.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.000000 721.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 208 319.500000 23962.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 102 162.000000 12150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 233 371.500000 20562.7500 55.3506
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 33 54.000000 4050.0000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 303 951.500000 63622.8000 66.8658
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 76 73.000000 3600.0000 49.3151
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 6.750000 162.5000 24.0741
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 15 19.000000 950.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 10 5.000000 125.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 4.000000 200.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 4 3.500000 87.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 11.750000 587.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 14.250000 712.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 8 7.750000 193.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 591 3527.000000 175110.0000 49.6484
INTR-T1013-INTERPRETER 28 122.000000 7683.0000 62.9754
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 942 7672.000000 76340.0000 9.9505
OCCT-97530-OT SESSION BY LICENSED OT 63 235.500000 14711.6800 62.4700
OCCT-97530HM-OT SESSION BY OT ASST 15 46.250000 2636.8600 57.0132
PHY-97110-PT SESSION BY LICENSED PT 110 405.500000 27960.2800 68.9526
PHY-97110HM-PT SESSION BY PT ASST 18 46.500000 2648.0000 56.9462
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 203 916.750000 63603.8100 69.3797
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 31.5800 7.8950
Subtotal (Total Children Is Unduplicated) 972 13120.75000 377350.2100 28.7598
-----------------------------------------------------------------------------------------------------------------------
Total 20043.500000 639062.5100 31.8838
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1788
-----------------------------------------------------------------------------------------------------------------------
Center 06
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 6401 6107.750000 136260.8400 136260.8400
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
18806 13935.750000 502801.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25207 20043.500000 639062.5100 136260.8400