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
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 398 200.000000 7381.5000 36.9075
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 344 410.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 262 704.250000 26001.7500 36.9212
Subtotal (Total Children Is Unduplicated) 678 1315.000000 33383.2500 25.3865
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 3 3.000000 150.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 412.4400 51.5550
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 177.8800 29.6467
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 654.0300 40.8769
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 17 39.000000 1707.4500 43.7808
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 65 79.750000 3987.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 2.750000 68.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 63 102.250000 5112.5000 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 34 59.750000 2987.5000 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 19 65.500000 3275.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 365 1895.000000 18950.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 22.500000 1607.4000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 3.000000 214.3200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 10.000000 571.6000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 53.500000 3539.0800 66.1510
TRAV-TRAVS-Travel by mile 359 24214.00000 10777.7300 0.4451
Subtotal (Total Children Is Unduplicated) 442 26636.25000 57385.1300 2.1544
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Total 27990.250000 92475.8300 3.3039
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Number of Children (Unduplicated) With at Least One Service 788
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Center 52
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 3 12.000000 105.5000 102.9500
D 5 5.750000 389.3400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2829 26154.500000 50583.2400 46249.3000
2850 1818.000000 41397.7500 20.0000
Other 0 0.000000 0.0000 0.0000
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Total 5687 27990.250000 92475.8300 46372.2500