CMS/EIP Fiscal Report Center: 03
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 718 484.000000 17908.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 399 357.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1079 2667.500000 98697.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1133 3509.250000 116605.5000 33.2280
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.000000 145.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 66.000000 4950.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 23.000000 1725.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 29.500000 2212.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 22.500000 1248.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 7.000000 525.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 3 5.000000 255.2500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 130.1700 32.5425
SCREEN-T1023-SCREENING 3 5.000000 250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 70 182.000000 12464.9700 68.4888
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 209 246.500000 12325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 243 470.250000 23512.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.250000 56.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 129 294.250000 14712.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 78 130.000000 6500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 198 304.750000 15237.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.750000 18.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 165 738.000000 36900.0000 50.0000
INTR-T1013-INTERPRETER 40 681.000000 24293.7500 35.6736
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 658 4847.000000 48470.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 41 192.500000 13006.5300 67.5664
OCCT-97530HM-OT SESSION BY OT ASST 1 5.000000 286.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 40 172.250000 10013.1200 58.1313
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 114.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 56 301.000000 20563.2800 68.3165
TRAV-TRAVS-Travel by mile 581 74917.00000 33346.3700 0.4451
Subtotal (Total Children Is Unduplicated) 705 83306.25000 259399.6200 3.1138
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Total 86997.500000 388470.0900 4.4653
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Number of Children (Unduplicated) With at Least One Service 1258
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Center 03
Flag Claims Units Chgs Paid
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R 22 27.750000 1377.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2770 1725.250000 69056.2500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 1.750000 64.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
15831 85242.750000 317971.5900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 18624 86997.500000 388470.0900 0.0000