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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 422 213.500000 7881.0000 36.9133
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 365 430.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 846 2306.750000 85183.2500 36.9278
Subtotal (Total Children Is Unduplicated) 922 2950.500000 93064.2500 31.5419
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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 15 29.500000 2212.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 20.000000 1500.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 12.000000 750.0000 62.5000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 37.500000 2081.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 178 366.000000 26150.0000 71.4481
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 80 170.000000 11900.0000 70.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 77.500000 5342.5000 68.9355
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 190 382.000000 20456.7500 53.5517
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) 276 1178.500000 74827.6500 63.4940
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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 660 5195.000000 51950.0000 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 601 52896.00000 23543.2100 0.4451
Subtotal (Total Children Is Unduplicated) 735 63502.75000 391694.4300 6.1681
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Total 67631.750000 559586.3300 8.2740
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Number of Children (Unduplicated) With at Least One Service 991
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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 949 1010.500000 52482.5000 175.7500
P 1906 1710.750000 75262.6400 72524.5900
D 169 178.250000 10746.4400 40.0000
S 44 52.000000 2964.3200 0.0000
H 146 147.000000 9886.2800 0.0000
T 6458 60260.000000 227384.1200 222433.9900
4346 4261.250000 180110.0300 560.8500
Other 0 0.000000 0.0000 0.0000
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Total 14027 67631.750000 559586.3300 295735.1800