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
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 1573 3424.750000 126688.0000 36.9919
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 705 604.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 659 2317.250000 85738.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1699 6346.250000 212426.2500 33.4727
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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 3 6.000000 347.5200 57.9200
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 297.5200 49.5867
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.500000 295.7500 45.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 37.500000 2314.6900 61.7251
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 22.500000 1391.5200 61.8453
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 9.500000 635.0200 66.8442
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 39 66.000000 3269.0000 49.5303
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 29 48.500000 3057.3000 63.0371
Subtotal (Total Children Is Unduplicated) 189 395.250000 21245.8200 53.7529
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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 2 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 47.000000 2350.0000 50.0000
INTR-T1013-INTERPRETER 99 198.250000 9912.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 21.4400 21.4400
PHY-97110-PT SESSION BY LICENSED PT 3 13.000000 688.7200 52.9785
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 36.000000 2256.8400 62.6900
Subtotal (Total Children Is Unduplicated) 153 346.500000 17585.7500 50.7525
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Total 7088.000000 251257.8200 35.4483
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Number of Children (Unduplicated) With at Least One Service 1725
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Center 09
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 8554 6796.750000 238505.5100 238505.5100
D 1 1.000000 71.4400 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
275 290.250000 12680.8700 92.5000
Other 0 0.000000 0.0000 0.0000
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Total 8830 7088.000000 251257.8200 238598.0100