CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 Page: 1
List order: No List
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 226 99.000000 3663.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 87 58.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1421 4982.250000 184343.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1424 5139.500000 188006.2500 36.5807
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 98 178.000000 8900.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 8.500000 471.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 198 184.500000 13837.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 256 271.500000 15068.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 103 119.500000 8962.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.000000 204.2000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 25 25.000000 1276.2500 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.000000 255.2500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 19 19.000000 969.9500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 73 75.000000 3828.7500 51.0500
Subtotal (Total Children Is Unduplicated) 490 907.500000 55061.9000 60.6743
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.500000 75.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 41 41.000000 2050.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 14.000000 700.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 143 145.000000 7250.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 311.000000 7775.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 927 6049.000000 302450.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1031 7124.000000 71240.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 149 543.250000 38809.7800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 70 173.500000 9924.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 74 224.250000 16020.4200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 75 293.250000 16762.1700 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 172 648.750000 46346.7000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 107 289.000000 16530.8000 57.2000
TRAV-TRAVS-Travel by mile 51 12461.00000 5545.3500 0.4450
Subtotal (Total Children Is Unduplicated) 1280 28318.50000 541479.4200 19.1210
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Total 34365.500000 784547.5700 22.8295
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Number of Children (Unduplicated) With at Least One Service 1729
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Center 57
Flag Claims Units Chgs Paid
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R 3 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2550 2410.500000 98379.2500 0.0000
P 915 930.405100 34560.5500 34216.3000
D 11 16.000000 592.0000 0.0000
S 153 348.750000 10266.7600 10266.7200
H 0 0.000000 0.0000 0.0000
T 3254 22231.344900 234644.2100 234644.2100
4805 8363.500000 404313.7100 306756.8000
Other 39 62.000000 1680.0900 1652.3400
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Total 11730 34365.500000 784547.5700 587536.3700