CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2017 ending 09/30/2017 Date of Report:11/05/2017 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 724 929.500000 34308.2500 36.9104
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 689 1640.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 850 2163.750000 79883.0000 36.9188
Subtotal (Total Children Is Unduplicated) 1065 4733.500000 114191.2500 24.1241
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 6.000000 291.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 3 2.250000 112.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 34.500000 2587.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 13.500000 1012.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 20.000000 1500.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 28.500000 1581.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 35.000000 2550.0000 72.8571
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.500000 637.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 75 123.000000 6815.5000 55.4106
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 93 163.999970 12262.4978 74.7713
Subtotal (Total Children Is Unduplicated) 172 442.749970 29913.2478 67.5624
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 57 63.000000 3150.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 291 518.750000 25925.0000 49.9759
CONIP-CONIP-CONSULT, ITDS PHONE 7 3.750000 93.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 14 30.000000 2199.6000 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 290 642.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 13.000000 325.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 354 1591.250000 79562.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 575 3070.000000 30700.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 16.000000 1143.0400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 4 11.000000 785.8400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 20.000000 1428.8000 71.4400
TRAV-TRAVS-Travel by mile 2 41.000000 18.2500 0.4451
Subtotal (Total Children Is Unduplicated) 579 6023.250000 145501.4400 24.1566
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Total 11199.499970 289605.9378 25.8588
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Number of Children (Unduplicated) With at Least One Service 1073
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Center 53
Flag Claims Units Chgs Paid
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R 9 7.500000 342.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 348 244.500000 9046.5000 0.0000
P 2631 2497.156640 113461.1602 113250.1600
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
10865 8413.343330 164907.1376 0.0000
Other 35 37.000000 1848.6400 0.0000
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Total 13888 11199.499970 289605.9378 113250.1600