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
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 855 1109.000000 40972.2500 36.9452
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 814 2559.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 242 714.000000 26316.2500 36.8575
Subtotal (Total Children Is Unduplicated) 1074 4382.500000 67288.5000 15.3539
-----------------------------------------------------------------------------------------------------------------------
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 5 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 19.000000 1425.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 18.000000 943.5000 52.4167
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 16.000000 1200.0000 75.0000
Subtotal (Total Children Is Unduplicated) 50 98.500000 6241.5000 63.3655
-----------------------------------------------------------------------------------------------------------------------
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 10 41.000000 3006.1200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 35 95.075000 4753.7500 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 622 3523.000000 35230.0000 10.0000
Subtotal (Total Children Is Unduplicated) 622 4313.075000 75077.3700 17.4069
-----------------------------------------------------------------------------------------------------------------------
Total 8794.075000 148607.3700 16.8986
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1079
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 27 27.000000 1396.6400 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
11898 8767.075000 147210.7300 17246.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11925 8794.075000 148607.3700 17246.7500