CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
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 398 211.000000 7807.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 286 195.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 795 2156.750000 79642.5000 36.9271
Subtotal (Total Children Is Unduplicated) 883 2563.500000 87449.5000 34.1133
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 13 13.000000 650.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 26.000000 1800.0000 69.2308
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 24.000000 1332.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 153 327.500000 23106.2700 70.5535
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 77 164.000000 11802.9700 71.9693
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 52.000000 3840.2900 73.8517
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 158 312.500000 17343.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 26.000000 1950.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 15 15.000000 765.7500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 37 37.000000 1850.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 26 26.000000 1326.2500 51.0096
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 267 1046.000000 67180.9300 64.2265
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 158 189.750000 9487.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 3.250000 81.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 130 189.500000 9475.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 5.750000 143.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 98 243.750000 12187.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 41 44.000000 2200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 103 161.000000 8050.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.500000 62.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 98 143.000000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 5.000000 207.0000 41.4000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 368 2243.000000 111760.0000 49.8261
INTR-T1013-INTERPRETER 3 32.250000 1612.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 631 5325.000000 53250.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 116 550.250000 39024.1000 70.9207
OCCT-97530HM-OT SESSION BY OT ASST 34 143.500000 8208.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 67 377.750000 25364.6400 67.1466
PHY-97110HM-PT SESSION BY PT ASST 3 23.000000 1314.6800 57.1600
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 262 1498.250000 105010.3800 70.0887
TRAV-TRAVS-Travel by mile 548 51457.00000 22903.0000 0.4451
Subtotal (Total Children Is Unduplicated) 687 62638.50000 410360.0000 6.5512
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Total 66248.000000 564990.4300 8.5284
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Number of Children (Unduplicated) With at Least One Service 941
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Center 52
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 71 77.750000 4126.2500 37.0000
P 2914 2660.250000 127487.4300 124822.7300
D 141 155.250000 8247.9600 0.0000
S 33 27.000000 1221.0000 0.0000
H 122 156.250000 10507.5900 0.0000
T 7053 59431.750000 253031.7500 241442.4900
3958 3739.750000 160368.4500 322.0600
Other 0 0.000000 0.0000 0.0000
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Total 14292 66248.000000 564990.4300 366624.2800