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
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 1334 1055.500000 39053.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 734 612.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 583 1628.250000 60245.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1537 3296.250000 99298.7500 30.1248
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 4 6.500000 325.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 10.500000 787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 9.500000 712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 16 42.500000 2737.8000 64.4188
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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 204 1548.750000 76197.5000 49.1994
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 39 157.750000 9157.2200 58.0489
OCCT-97530HM-OT SESSION BY OT ASST 7 23.500000 1335.5600 56.8323
PHY-97110-PT SESSION BY LICENSED PT 61 264.750000 17905.1000 67.6302
PHY-97110HM-PT SESSION BY PT ASST 4 15.500000 876.0400 56.5187
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 131 645.000000 44189.9900 68.5116
SPL-92508-GROUP SPL SESSION PER CHILD 1 3.000000 17.7000 5.9000
Subtotal (Total Children Is Unduplicated) 972 10597.50000 240327.1100 22.6777
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Total 13936.250000 342363.6600 24.5664
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Number of Children (Unduplicated) With at Least One Service 1721
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Center 06
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 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
11255 7828.500000 206102.8200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 17656 13936.250000 342363.6600 136260.8400