CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2016 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 1811 3989.750000 147394.2500 36.9432
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1647 10700.75000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2105 11599.75000 428051.6900 36.9018
Subtotal (Total Children Is Unduplicated) 2245 26290.25000 575445.9400 21.8882
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 4 6.000000 300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 48 63.250000 3162.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 58 152.500000 11287.5000 74.0164
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 69 192.500000 14362.5000 74.6104
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 38 69.000000 5137.5000 74.4565
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 88 185.500000 10295.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 79 133.000000 9975.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 40 75.000000 5625.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 35 60.500000 4537.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 442 777.500000 43084.7500 55.4145
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 470 839.500000 62962.5000 75.0000
Subtotal (Total Children Is Unduplicated) 794 2555.750000 170842.5000 66.8463
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 213 283.000000 14112.5000 49.8675
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 746 2380.000000 118893.5000 49.9553
CONIP-CONIP-CONSULT, ITDS PHONE 121 69.500000 1737.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 8.000000 400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 31 195.000000 14297.4000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 32 111.500000 2787.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 675 7811.500000 390642.5000 50.0086
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1232 14507.00000 145000.0000 9.9952
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 50.0000 50.0000
TRAV-TRAVS-Travel by mile 1 1.000000 0.4500 0.4500
Subtotal (Total Children Is Unduplicated) 1235 25373.50000 688096.3500 27.1187
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Total 54219.500000 1434384.7900 26.4551
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Number of Children (Unduplicated) With at Least One Service 2245
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Center 53
Flag Claims Units Chgs Paid
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R 22 22.000000 960.5000 592.0000
U 0 0.000000 0.0000 0.0000
B 940 852.500000 37700.5000 6003.2500
P 15999 15111.205000 684678.3500 667626.2500
D 60 63.750000 3330.0700 0.0000
S 825 775.500000 28522.9400 28367.4400
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
48676 37324.295000 675639.1800 43766.5000
Other 73 70.250000 3553.2500 0.0000
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Total 66595 54219.500000 1434384.7900 746355.4400