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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.250000 9.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.250000 9.2500 37.0000
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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 176 348.750000 17375.0000 49.8208
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 402.5000 73.1818
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 17.500000 943.5000 53.9143
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 54 95.500000 6511.4200 68.1824
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 44.5100 22.2550
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 127 210.000000 11335.9900 53.9809
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 50.500000 3446.6000 68.2495
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 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 369 756.750000 41425.0000 54.7407
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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 171 228.250000 11087.5000 48.5761
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 80 190.500000 9525.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 19.500000 975.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 23 43.000000 2150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 66 133.500000 6675.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 351 2316.750000 115729.5000 49.9534
INTR-T1013-INTERPRETER 98 360.250000 18007.5000 49.9861
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1378 11333.00000 112736.9300 9.9477
OCCT-97530-OT SESSION BY LICENSED OT 31 178.500000 12106.8600 67.8255
PHY-97110-PT SESSION BY LICENSED PT 42 307.250000 19367.3300 63.0344
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 143 967.000000 64368.0400 66.5647
TRAV-TRAVS-Travel by mile 778 74112.00000 31845.2100 0.4297
Subtotal (Total Children Is Unduplicated) 1443 90197.50000 409949.6800 4.5450
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Total 90954.500000 451383.9300 4.9627
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Number of Children (Unduplicated) With at Least One Service 1524
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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 19411 77908.000000 379760.2100 379760.2100
D 1115 5219.250000 35267.5800 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 55.5000 0.0000
T 1221 7413.500000 19721.4800 19721.4800
23 154.750000 901.0000 0.0000
Other 207 258.000000 15678.1600 0.0000
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Total 21978 90954.500000 451383.9300 399481.6900