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: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 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 6663.500000 246242.7400 36.9540
Subtotal (Total Children Is Unduplicated) 2486 7805.750000 253226.4900 32.4410
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 24.000000 1800.0000 75.0000
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 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 109 151.500000 11362.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 35 53.000000 3975.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 74.500000 5587.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 56 81.000000 4495.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 63.500000 4762.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 269 495.000000 35276.1500 71.2649
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 18 23.250000 1162.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 18.500000 925.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 18.500000 925.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 14.000000 700.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 69 293.500000 14675.0000 50.0000
INTR-T1013-INTERPRETER 132 253.500000 12675.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 2.000000 20.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 25.000000 1786.0000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 3.000000 171.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 35 131.000000 9358.6400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 72 322.000000 23003.6800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 6 23.000000 315.3600 13.7113
Subtotal (Total Children Is Unduplicated) 321 1129.250000 65799.9400 58.2687
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Total 9430.000000 354302.5800 37.5719
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Number of Children (Unduplicated) With at Least One Service 2505
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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 102 104.500000 5357.8000 5357.8000
D 62 64.000000 4324.2700 0.0000
S 164 139.250000 7080.9300 0.0000
H 259 279.000000 19122.5600 0.0000
T 0 0.000000 0.0000 0.0000
5816 3970.750000 125731.3100 0.0000
Other 1 1.500000 112.5000 0.0000
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Total 13682 9430.000000 354302.5800 5357.8000