CMS/EIP Fiscal Report Center: 54
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 60 35.750000 1322.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 130 249.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 140 594.750000 21987.2500 36.9689
Subtotal (Total Children Is Unduplicated) 142 880.000000 23310.0000 26.4886
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 62 99.500000 7462.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 47.000000 3525.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 73 118.500000 6576.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 43.000000 3225.0000 75.0000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 120 339.500000 22984.7500 67.7018
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 120 226.000000 2260.0000 10.0000
TRAV-TRAVS-Travel by mile 63 1201.000000 534.5700 0.4451
Subtotal (Total Children Is Unduplicated) 120 1429.000000 2894.5700 2.0256
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Total 2648.500000 49189.3200 18.5725
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Number of Children (Unduplicated) With at Least One Service 142
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Center 54
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 487 490.500000 21800.5000 0.0000
P 49 62.250000 4090.7500 4090.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 74 541.500000 1562.0500 1562.0500
T 79 646.000000 1690.7400 1690.7400
891 908.250000 20045.2800 4405.6600
Other 0 0.000000 0.0000 0.0000
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Total 1580 2648.500000 49189.3200 11749.2000