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
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 677 867.000000 32014.2500 36.9253
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 715 2486.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 192 545.750000 20192.7500 37.0000
Subtotal (Total Children Is Unduplicated) 953 3899.250000 52207.0000 13.3890
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 12 15.000000 750.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 14.000000 1050.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 15.000000 1050.0000 70.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 29.000000 1609.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.000000 1950.0000 75.0000
Subtotal (Total Children Is Unduplicated) 58 112.500000 7275.7500 64.6733
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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 291 568.000000 28362.5000 49.9340
CONIP-CONIP-CONSULT, ITDS PHONE 51 31.750000 793.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 14 41.000000 3006.1200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 40.000000 2000.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 595 3333.000000 33310.0000 9.9940
Subtotal (Total Children Is Unduplicated) 596 4073.500000 70354.4700 17.2713
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Total 8085.250000 129837.2200 16.0585
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Number of Children (Unduplicated) With at Least One Service 960
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Center 53
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 0 0.000000 0.0000 0.0000
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
10614 8085.250000 129837.2200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10614 8085.250000 129837.2200 0.0000