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
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 617 506.500000 18740.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 893 2927.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 303 720.250000 26593.7500 36.9229
Subtotal (Total Children Is Unduplicated) 1125 4154.500000 45334.2500 10.9121
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 6.000000 291.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 14 28.500000 1425.0000 50.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 27.500000 2062.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.500000 637.5000 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 8 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
Subtotal (Total Children Is Unduplicated) 49 103.000000 6590.2500 63.9830
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 44 21.250000 1062.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 513 498.750000 24937.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 11.000000 550.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 79 414.500000 20725.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 788 3750.000000 37490.0000 9.9973
TRAV-TRAVS-Travel by mile 1 10.000000 4.4600 0.4460
Subtotal (Total Children Is Unduplicated) 802 4706.750000 84800.7100 18.0168
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Total 8964.250000 136725.2100 15.2523
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Number of Children (Unduplicated) With at Least One Service 1134
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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 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
11857 8964.250000 136725.2100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11857 8964.250000 136725.2100 0.0000