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
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 855 2153.750000 79614.7500 36.9656
Subtotal (Total Children Is Unduplicated) 1702 3296.000000 86598.5000 26.2738
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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 3 5.000000 375.0000 75.0000
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 4 5.000000 375.0000 75.0000
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 1 1.500000 83.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 9.000000 675.0000 75.0000
Subtotal (Total Children Is Unduplicated) 20 37.000000 2606.7500 70.4527
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 21.250000 1062.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 18.500000 925.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 10.000000 500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 12.000000 600.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 11.000000 550.0000 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 1 2.000000 142.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 6 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 12 36.000000 2571.8400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 9.000000 124.9200 13.8800
Subtotal (Total Children Is Unduplicated) 191 387.250000 20015.1400 51.6853
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Total 3720.250000 109220.3900 29.3583
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Number of Children (Unduplicated) With at Least One Service 1745
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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 0 0.000000 0.0000 0.0000
D 3 3.500000 136.9400 0.0000
S 2 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5604 3716.250000 109064.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5609 3720.250000 109220.3900 0.0000