CMS/EIP Fiscal Report Center: 52
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 404 202.500000 7474.0000 36.9086
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 344 412.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 775 2020.750000 74610.5000 36.9222
Subtotal (Total Children Is Unduplicated) 851 2635.500000 82084.5000 31.1457
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 51.0500 25.5250
EXIT-EXIT-EXIT ASSESSMENT 4 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 8.000000 450.0000 56.2500
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 24.000000 1332.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 131 270.000000 19460.0000 72.0741
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 64 134.000000 9540.0000 71.1940
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 46.000000 3450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 137 280.500000 14934.5000 53.2424
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 11.000000 561.5500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 36 36.000000 1800.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 217 874.500000 55701.1500 63.6949
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.000000 268.6000 134.3000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 143 183.750000 9187.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 2.750000 68.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 139 235.000000 11750.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 9 4.750000 118.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 90 138.000000 6900.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 1.250000 31.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 47 74.250000 3712.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 96 127.750000 6387.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 325 1908.750000 95093.5200 49.8198
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 649 5172.000000 51720.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 96 415.750000 28874.5600 69.4517
OCCT-97530HM-OT SESSION BY OT ASST 19 87.250000 4990.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 79 429.500000 29594.0200 68.9034
PHY-97110HM-PT SESSION BY PT ASST 7 72.500000 4144.1000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 296 1724.500000 114992.3900 66.6816
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 12.0800 12.0800
TRAV-TRAVS-Travel by mile 562 51635.00000 22981.9100 0.4451
Subtotal (Total Children Is Unduplicated) 694 62218.75000 390903.1300 6.2827
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Total 65728.750000 528688.7800 8.0435
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Number of Children (Unduplicated) With at Least One Service 920
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Center 52
Flag Claims Units Chgs Paid
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R 9 12.000000 750.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 893 912.500000 46314.7500 175.7500
P 1727 1498.250000 66261.3800 63656.1200
D 163 167.250000 10096.9400 40.0000
S 42 48.000000 2664.3200 0.0000
H 145 145.000000 9736.2800 0.0000
T 6352 58944.500000 224881.9200 219934.7900
4111 4001.250000 167983.1900 560.8500
Other 0 0.000000 0.0000 0.0000
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Total 13442 65728.750000 528688.7800 284367.5100