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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1270 976.750000 36139.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 693 795.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1764 5396.250000 199661.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1896 7168.500000 235801.0000 32.8941
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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 12 24.000000 1800.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 20.500000 1137.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 54 103.500000 7697.7000 74.3739
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 220 414.000000 22977.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 238 522.500000 39187.5000 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) 398 1187.750000 78025.0500 65.6915
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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 174 251.500000 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 1018 4500.000000 45780.0000 10.1733
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 8 201.000000 89.4500 0.4450
Subtotal (Total Children Is Unduplicated) 1137 6829.260000 150235.3400 21.9988
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Total 15185.510000 464061.3900 30.5595
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Number of Children (Unduplicated) With at Least One Service 2001
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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 11 8.000000 524.0000 0.0000
P 8120 10736.760000 324056.8900 324056.8900
D 210 171.750000 7360.2500 0.0000
S 6 9.750000 373.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.500000 18.5000 0.0000
6417 4245.750000 131171.0000 0.0000
Other 2 0.500000 18.5000 0.0000
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Total 14786 15185.510000 464061.3900 324056.8900