CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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 1573 3424.750000 126688.0000 36.9919
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 716 675.250000 71.4400 0.1058
TCM-T1017TL-TARGETED CASE MANAGEMENT 1622 5427.250000 200789.7500 36.9966
Subtotal (Total Children Is Unduplicated) 1809 9527.250000 327549.1900 34.3802
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 99 192.750000 9637.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 16.500000 1135.0200 68.7891
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 13.000000 822.5200 63.2708
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 17.000000 878.5000 51.6765
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 112 167.500000 11984.6900 71.5504
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 115 155.000000 11266.5200 72.6872
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 40.500000 2960.0200 73.0869
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 218 339.500000 18295.7700 53.8903
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 73 119.000000 8344.8000 70.1244
Subtotal (Total Children Is Unduplicated) 490 1070.250000 66037.8400 61.7032
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 23 34.000000 1700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 8.250000 206.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 3.000000 150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 7.000000 350.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 101 503.500000 25175.0000 50.0000
INTR-T1013-INTERPRETER 99 198.250000 9912.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 40.000000 2789.7400 69.7435
PHY-97110-PT SESSION BY LICENSED PT 6 23.000000 1403.1200 61.0052
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 165.000000 11372.6000 68.9248
Subtotal (Total Children Is Unduplicated) 237 990.000000 53459.2100 53.9992
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Total 11587.500000 447046.2400 38.5800
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Number of Children (Unduplicated) With at Least One Service 1826
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Center 09
Flag Claims Units Chgs Paid
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R 2 3.500000 129.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 220 191.750000 7419.7500 27.7500
P 12833 10861.250000 410872.9500 411031.3500
D 7 10.000000 671.0700 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
447 517.500000 27729.4700 163.9600
Other 2 3.500000 223.5000 0.0000
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Total 13511 11587.500000 447046.2400 411223.0600