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
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 1517 3650.250000 135059.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 741 638.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 645 2243.750000 82991.0000 36.9876
Subtotal (Total Children Is Unduplicated) 1695 6532.750000 218050.2500 33.3780
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 115 230.500000 11525.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 92.5000 61.6667
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.500000 971.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.000000 322.5200 64.5040
Subtotal (Total Children Is Unduplicated) 128 256.000000 13023.7700 50.8741
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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 167 172.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 69.000000 3450.0000 50.0000
INTR-T1013-INTERPRETER 96 184.500000 9225.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 142.8800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 7.000000 500.0800 71.4400
Subtotal (Total Children Is Unduplicated) 270 495.000000 16230.4600 32.7888
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Total 7283.750000 247304.4800 33.9529
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Number of Children (Unduplicated) With at Least One Service 1733
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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 0 0.000000 0.0000 0.0000
P 8665 7246.750000 245924.7300 245924.7300
D 0 0.000000 0.0000 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
27 35.000000 1268.7500 0.0000
Other 1 2.000000 111.0000 0.0000
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Total 8693 7283.750000 247304.4800 245924.7300