CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
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 536 188.750000 6983.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 973 953.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2453 6663.750000 246251.9900 36.9540
Subtotal (Total Children Is Unduplicated) 2486 7806.000000 253235.7400 32.4412
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 17 17.000000 809.6300 47.6253
EXIT-EXIT-EXIT ASSESSMENT 177 352.750000 17575.0000 49.8228
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 29.500000 2202.5000 74.6610
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 26.500000 1987.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 22.500000 1221.0000 54.2667
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 163 247.000000 17873.9200 72.3640
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 55.000000 4125.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 50 76.500000 5632.0100 73.6210
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 183 291.000000 15831.4900 54.4037
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 80 114.000000 8209.1000 72.0096
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 99.5500 49.7750
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 530 1251.750000 76701.1500 61.2751
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 6.000000 5339.8100 889.9683
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 186 251.500000 12250.0000 48.7078
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 87 209.000000 10450.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 19.500000 975.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 39 61.500000 3075.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 76 147.500000 7375.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 416 2610.250000 130404.5000 49.9586
INTR-T1013-INTERPRETER 204 613.750000 30682.5000 49.9919
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1379 11335.00000 112756.9300 9.9477
OCCT-97530-OT SESSION BY LICENSED OT 40 203.500000 13892.8600 68.2696
OCCT-97530HM-OT SESSION BY OT ASST 1 3.000000 171.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 77 438.250000 28725.9700 65.5470
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 215 1289.000000 87371.7200 67.7826
SPL-92508-GROUP SPL SESSION PER CHILD 6 23.000000 315.3600 13.7113
TRAV-TRAVS-Travel by mile 778 74112.00000 31845.2100 0.4297
Subtotal (Total Children Is Unduplicated) 1598 91326.75000 475749.6200 5.2093
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Total 100384.500000 805686.5100 8.0260
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Number of Children (Unduplicated) With at Least One Service 2635
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Center 01
Flag Claims Units Chgs Paid
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R 3 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 7275 4870.250000 192545.4600 0.0000
P 19513 78012.500000 385118.0100 385118.0100
D 1177 5283.250000 39591.8500 0.0000
S 164 139.250000 7080.9300 0.0000
H 260 280.000000 19178.0600 0.0000
T 1221 7413.500000 19721.4800 19721.4800
5839 4125.500000 126632.3100 0.0000
Other 208 259.500000 15790.6600 0.0000
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Total 35660 100384.500000 805686.5100 404839.4900