CMS/EIP Fiscal Report Center: 09
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
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 1517 3650.250000 135059.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 741 638.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1659 5762.750000 213194.0000 36.9952
Subtotal (Total Children Is Unduplicated) 1825 10051.75000 348253.2500 34.6460
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 127 254.500000 12725.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.500000 602.5000 63.4211
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.000000 405.0000 67.5000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.000000 700.0000 70.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 388.7700 43.1967
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 118 177.500000 13089.2000 73.7420
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 105 152.000000 10845.0400 71.3489
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 43.000000 3205.0000 74.5349
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 220 371.500000 20118.8200 54.1556
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 80 125.000000 8764.3000 70.1144
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 533 1168.500000 71415.5800 61.1173
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 29 41.250000 2062.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 6.000000 300.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 6.000000 300.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 250 343.000000 35.7200 0.1041
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 65 339.750000 16987.5000 50.0000
INTR-T1013-INTERPRETER 96 184.500000 9225.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 31.000000 2148.2800 69.2994
PHY-97110-PT SESSION BY LICENSED PT 6 18.000000 1128.7600 62.7089
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 141.250000 9811.0200 69.4585
Subtotal (Total Children Is Unduplicated) 346 1117.750000 42248.7800 37.7981
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Total 12338.000000 461917.6100 37.4386
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Number of Children (Unduplicated) With at Least One Service 1863
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Center 09
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 56 61.750000 3084.7500 0.0000
P 13526 12080.250000 447694.3100 447867.7770
D 16 20.000000 1399.7100 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
135 174.000000 9627.8400 0.0000
Other 1 2.000000 111.0000 0.0000
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Total 13734 12338.000000 461917.6100 447867.7770