CMS/EIP Fiscal Report Center: 53
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 677 867.000000 32014.2500 36.9253
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 715 2492.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 856 2537.000000 93619.2500 36.9016
Subtotal (Total Children Is Unduplicated) 1033 5896.000000 125633.5000 21.3083
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 13 16.000000 800.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 48.000000 3600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 45.000000 3300.0000 73.3333
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 41.000000 2275.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 36.500000 2737.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 21.500000 1612.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 105 182.000000 10101.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 110 197.500000 14850.0000 75.1899
Subtotal (Total Children Is Unduplicated) 200 602.500000 40401.5000 67.0564
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 19.6000 19.6000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 60 55.750000 2787.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 291 569.000000 28412.5000 49.9341
CONIP-CONIP-CONSULT, ITDS PHONE 51 31.750000 793.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 18 51.000000 3739.3200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 14.000000 350.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 354 1830.500000 91512.5000 49.9932
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 595 3343.000000 33410.0000 9.9940
Subtotal (Total Children Is Unduplicated) 596 5897.000000 161050.1700 27.3105
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Total 12395.500000 327085.1700 26.3874
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Number of Children (Unduplicated) With at Least One Service 1035
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Center 53
Flag Claims Units Chgs Paid
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R 6 4.250000 157.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 550 529.750000 25699.5000 0.0000
P 2814 2660.500000 119138.5000 119138.5000
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
11664 9185.500000 181318.1700 0.0000
Other 17 15.500000 771.7500 0.0000
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Total 15051 12395.500000 327085.1700 119138.5000