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
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 718 484.000000 17908.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 399 357.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 409 1077.750000 39876.7500 37.0000
Subtotal (Total Children Is Unduplicated) 955 1919.500000 57784.7500 30.1041
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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
OCTH-97165-OT EVAL LOW COMPLEXITY 2 4.000000 204.2000 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 2 2.000000 100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 17 20.000000 935.1200 46.7560
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 177 209.000000 10450.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 187 310.500000 15525.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.250000 56.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 124 250.250000 12512.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 77 121.000000 6050.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 194 289.750000 14487.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.750000 18.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 144 535.250000 26762.5000 50.0000
INTR-T1013-INTERPRETER 28 348.500000 13907.5000 39.9067
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 642 4071.000000 40710.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 33 160.500000 10984.0500 68.4364
PHY-97110-PT SESSION BY LICENSED PT 36 157.250000 9259.1600 58.8818
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 265.500000 18027.1600 67.8989
TRAV-TRAVS-Travel by mile 560 62758.00000 27933.9600 0.4451
Subtotal (Total Children Is Unduplicated) 665 69481.25000 206728.0800 2.9753
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Total 71420.750000 265447.9500 3.7167
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Number of Children (Unduplicated) With at Least One Service 1146
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Center 03
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
13656 71420.750000 265447.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13656 71420.750000 265447.9500 0.0000