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
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 1183 918.500000 33984.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 624 718.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 574 1724.750000 63815.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1530 3361.250000 97800.2500 29.0964
-----------------------------------------------------------------------------------------------------------------------
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 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 37.000000 2710.2000 73.2486
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 83 161.000000 8935.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 69 151.500000 11362.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 166 452.750000 28352.1500 62.6221
-----------------------------------------------------------------------------------------------------------------------
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 278 1064.500000 52300.7000 49.1317
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 10 42.000000 2937.4700 69.9398
PHY-97110-PT SESSION BY LICENSED PT 3 9.500000 588.0900 61.9042
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 187.000000 12864.1700 68.7924
TRAV-TRAVS-Travel by mile 7 175.000000 77.8800 0.4450
Subtotal (Total Children Is Unduplicated) 1092 6482.000000 134067.8100 20.6831
-----------------------------------------------------------------------------------------------------------------------
Total 10296.000000 260220.2100 25.2739
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1780
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 2900 6359.000000 137745.2100 137745.2100
D 189 144.250000 5898.0000 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
5876 3792.750000 116577.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8965 10296.000000 260220.2100 137745.2100