CMS/EIP Fiscal Report Center: 05
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 286 144.250000 5337.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 337 347.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 357 993.500000 36741.0000 36.9814
Subtotal (Total Children Is Unduplicated) 632 1484.750000 42078.2500 28.3403
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 6 6.000000 300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 29.500000 2212.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 16.500000 1237.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 12.500000 937.5000 75.0000
Subtotal (Total Children Is Unduplicated) 39 71.000000 5175.0000 72.8873
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 3.750000 187.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 2.500000 125.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 5.500000 275.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.500000 12.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 39.250000 1962.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14 26.000000 260.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 1 6.750000 482.2200 71.4400
TRAV-TRAVS-Travel by mile 13 455.000000 202.5000 0.4451
Subtotal (Total Children Is Unduplicated) 39 542.500000 3588.4700 6.6147
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Total 2098.250000 50841.7200 24.2305
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Number of Children (Unduplicated) With at Least One Service 640
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Center 05
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 134 613.500000 8763.4700 8763.4700
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
2465 1484.750000 42078.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2599 2098.250000 50841.7200 8763.4700