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
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 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
EXIT-EXIT-EXIT ASSESSMENT 4 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 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 1 2.000000 150.0000 75.0000
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 84 170.000000 12410.0000 73.0000
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 12 24.000000 1800.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 137 280.500000 14934.5000 53.2424
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 36 36.000000 1800.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 197 699.500000 43873.8500 62.7217
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 66 80.750000 4037.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 2.750000 68.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 64 103.750000 5187.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 1.750000 43.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 29.250000 1462.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 35 61.500000 3075.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 69 94.250000 4712.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 174 900.750000 45037.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 365 1900.000000 19000.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 24 95.000000 6786.8000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 11 35.500000 2536.1200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 7 72.500000 4144.1000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 94 410.000000 28983.8600 70.6923
TRAV-TRAVS-Travel by mile 359 24292.00000 10812.4500 0.4451
Subtotal (Total Children Is Unduplicated) 444 28082.75000 135963.3300 4.8415
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Total 31417.750000 261921.6800 8.3367
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Number of Children (Unduplicated) With at Least One Service 883
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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 1726 1495.250000 66101.3800 63496.1200
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 2850 26255.250000 51876.6800 47109.7300
3364 2382.500000 74381.3300 20.0000
Other 0 0.000000 0.0000 0.0000
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Total 9192 31417.750000 261921.6800 110841.6000