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
Payclass Filters:GR
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 856 2154.000000 79624.0000 36.9656
Subtotal (Total Children Is Unduplicated) 1703 3296.250000 86607.7500 26.2746
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 16.000000 761.1300 47.5706
EXIT-EXIT-EXIT ASSESSMENT 177 352.750000 17575.0000 49.8228
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.500000 477.5000 73.4615
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 38.500000 2559.6400 66.4842
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 76.500000 4037.7400 52.7809
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 24.500000 1571.6000 64.1469
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 48.5000 48.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 256 530.250000 28031.7100 52.8651
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 1991.6900 995.8450
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 184 249.500000 12150.0000 48.6974
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 87 209.000000 10450.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 19.500000 975.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 33 53.000000 2650.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 76 145.500000 7275.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 156 724.250000 36129.5000 49.8854
INTR-T1013-INTERPRETER 204 612.750000 30632.5000 49.9918
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1379 11335.00000 112756.9300 9.9477
OCCT-97530-OT SESSION BY LICENSED OT 14 63.000000 4294.5600 68.1676
PHY-97110-PT SESSION BY LICENSED PT 31 169.000000 11469.7500 67.8683
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 85 426.500000 28653.4200 67.1827
SPL-92508-GROUP SPL SESSION PER CHILD 1 9.000000 124.9200 13.8800
TRAV-TRAVS-Travel by mile 778 74112.00000 31845.2100 0.4297
Subtotal (Total Children Is Unduplicated) 1521 88131.00000 291455.6400 3.3071
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Total 91957.500000 406095.1000 4.4161
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Number of Children (Unduplicated) With at Least One Service 2225
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Center 01
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 17416 75893.750000 267894.6000 267894.6000
D 751 4853.500000 13031.0100 0.0000
S 2 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 1153 7346.750000 15746.0400 15746.0400
5623 3863.000000 109404.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 24945 91957.500000 406095.1000 283640.6400