CMS/EIP Fiscal Report Center: 07
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 1183 918.500000 33984.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 624 718.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1656 4929.750000 182400.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1784 6566.250000 216385.2500 32.9542
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 48 81.750000 4087.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 74.000000 5485.2000 74.1243
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 75.0000 50.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 170 326.500000 18120.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 178 402.000000 30150.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 317 931.750000 60658.0500 65.1012
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 3773.2500 943.3125
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 43 47.250000 2362.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 108 255.000000 12660.0000 49.6471
CONIP-CONIP-CONSULT, ITDS PHONE 10 12.250000 306.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 4.750000 237.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 141 190.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 304 1130.250000 55588.2000 49.1822
INTR-T1013-INTERPRETER 2 7.000000 350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1007 4483.000000 45610.0000 10.1740
OCCT-97530-OT SESSION BY LICENSED OT 13 53.000000 3723.3100 70.2511
PHY-97110-PT SESSION BY LICENSED PT 7 29.260000 1999.0300 68.3195
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 89 334.000000 23365.8500 69.9576
TRAV-TRAVS-Travel by mile 7 175.000000 77.8800 0.4450
Subtotal (Total Children Is Unduplicated) 1094 6725.510000 150053.7700 22.3111
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Total 14223.510000 427097.0700 30.0275
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Number of Children (Unduplicated) With at Least One Service 1888
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Center 07
Flag Claims Units Chgs Paid
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R 19 12.500000 538.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 8 7.250000 496.2500 0.0000
P 7713 10248.760000 302882.3200 302882.3200
D 189 144.250000 5898.0000 0.0000
S 5 9.500000 364.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.500000 18.5000 0.0000
5892 3800.250000 116880.5000 0.0000
Other 2 0.500000 18.5000 0.0000
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Total 13829 14223.510000 427097.0700 302882.3200