CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2017 ending 06/30/2017 Date of Report:08/05/2017 Page: 1
List order: No List
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 775 1076.500000 39775.0000 36.9484
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 852 2734.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 263 668.750000 24642.0000 36.8479
Subtotal (Total Children Is Unduplicated) 1109 4480.000000 64417.0000 14.3788
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 11 15.250000 762.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 23 23.000000 1725.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.000000 721.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.251822 618.8867 75.0000
Subtotal (Total Children Is Unduplicated) 52 93.501822 6113.3867 65.3825
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 86 92.500000 4587.5000 49.5946
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 329 772.500000 38593.5000 49.9592
CONIP-CONIP-CONSULT, ITDS PHONE 41 18.500000 462.5000 25.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 9 17.000000 1246.4400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 13.500000 337.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 42 165.500000 8275.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 810 6661.500000 66585.0000 9.9955
TRAV-TRAVS-Travel by mile 436 43208.00000 19230.5000 0.4451
Subtotal (Total Children Is Unduplicated) 810 50951.75000 139386.6900 2.7357
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Total 55525.251822 209917.0767 3.7806
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Number of Children (Unduplicated) With at Least One Service 1167
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Center 53
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 2 1.250000 59.2500 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 5935 46476.501822 65060.1367 65060.1400
11956 9047.500000 144797.6900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 17893 55525.251822 209917.0767 65060.1400