CMS/EIP Fiscal Report Center: 53
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 855 1109.000000 40972.2500 36.9452
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 814 2561.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1006 2956.500000 109156.9400 36.9210
Subtotal (Total Children Is Unduplicated) 1153 6627.000000 150129.1900 22.6542
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 13 17.000000 850.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 21.000000 1575.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 41.000000 3075.0000 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 9 17.500000 1312.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 60.000000 3330.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.000000 1125.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 22.000000 1650.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.000000 1200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 106 177.500000 9795.7500 55.1873
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 115 201.000000 15075.0000 75.0000
Subtotal (Total Children Is Unduplicated) 217 593.500000 39300.7500 66.2186
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 61 63.750000 3187.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 303 567.750000 28337.5000 49.9119
CONIP-CONIP-CONSULT, ITDS PHONE 31 16.750000 418.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 15 49.000000 3592.6800 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 25.000000 625.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 363 1855.250000 92780.0000 50.0094
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 622 3523.000000 35230.0000 10.0000
Subtotal (Total Children Is Unduplicated) 622 6102.250000 164215.1800 26.9106
-----------------------------------------------------------------------------------------------------------------------
Total 13322.750000 353645.1200 26.5445
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1154
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 133 137.250000 6642.2500 0.0000
P 3810 3549.425000 159377.6400 158416.0000
D 3 3.000000 150.0000 0.0000
S 447 315.750000 11615.6900 11615.6900
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
12402 9300.075000 175000.2900 17884.2500
Other 18 17.250000 859.2500 0.0000
---------------------------------------------------------
Total 16813 13322.750000 353645.1200 187915.9400