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
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 776 1076.750000 39784.2500 36.9485
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 852 2739.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1034 2987.000000 110270.2500 36.9167
Subtotal (Total Children Is Unduplicated) 1170 6803.250000 150054.5000 22.0563
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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 12 16.250000 812.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 45.000000 3375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 22 55.500000 4162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 23.000000 1687.5000 73.3696
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 35.000000 1942.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 40.500000 3037.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 14.500000 1087.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 28.500000 2137.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 165.000000 9146.5000 55.4333
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 108 200.000000 14962.5000 74.8125
Subtotal (Total Children Is Unduplicated) 222 625.250000 42451.5000 67.8952
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 77 87.500000 4337.5000 49.5714
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 318 571.500000 28543.5000 49.9449
CONIP-CONIP-CONSULT, ITDS PHONE 30 13.000000 325.0000 25.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 12 32.000000 2346.2400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 52.500000 1312.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 402 2047.250000 102362.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 632 3715.000000 37120.0000 9.9919
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 635 6521.750000 176447.2400 27.0552
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Total 13950.250000 368953.2400 26.4478
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Number of Children (Unduplicated) With at Least One Service 1172
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Center 53
Flag Claims Units Chgs Paid
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R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 427 347.500000 14617.5000 1387.5000
P 3909 3733.950000 168488.0000 167638.2500
D 10 12.000000 661.0000 0.0000
S 3 2.500000 118.5000 18.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
12752 9827.050000 183776.9900 0.0000
Other 31 26.750000 1272.7500 0.0000
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Total 17133 13950.250000 368953.2400 169044.2500