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: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 618 1897.250000 70198.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1635 3669.500000 106338.0000 28.9789
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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 5 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 53.500000 3947.7000 73.7888
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 101 193.000000 10711.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 93 203.500000 15262.5000 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) 200 562.250000 35872.4000 63.8015
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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 278 1064.500000 52300.7000 49.1317
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 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 8 201.000000 89.4500 0.4450
Subtotal (Total Children Is Unduplicated) 1135 6585.750000 134249.3800 20.3848
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Total 10817.500000 276459.7800 25.5567
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Number of Children (Unduplicated) With at Least One Service 1887
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Center 07
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 2921 6407.500000 138232.0300 138232.0300
D 210 171.750000 7360.2500 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
6401 4238.250000 130867.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9532 10817.500000 276459.7800 138232.0300