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
Payclass Filters:TPIN
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 1 0.250000 9.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 11 12.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 24 84.750000 3080.2500 36.3451
Subtotal (Total Children Is Unduplicated) 35 97.500000 3089.5000 31.6872
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 487.5000 69.6429
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 25.500000 1912.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 15.500000 1162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 63 132.000000 7315.0000 55.4167
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 77 135.500000 10200.0000 75.2768
Subtotal (Total Children Is Unduplicated) 123 371.000000 24887.7500 67.0829
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 4 8.000000 586.5600 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 14.000000 350.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 157 1753.980000 87766.5000 50.0385
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10 11.000000 110.0000 10.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 163 1788.980000 88913.0600 49.7004
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Total 2257.480000 116890.3100 51.7791
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Number of Children (Unduplicated) With at Least One Service 216
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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 225 206.130000 10082.0000 8985.7500
D 24 27.750000 1506.7500 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
1802 1958.600000 101929.5600 3271.7500
Other 65 65.000000 3372.0000 0.0000
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Total 2116 2257.480000 116890.3100 12257.5000