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
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 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 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 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 102 220.000000 15493.7700 70.4262
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 21 40.000000 2940.2900 73.5073
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 158 312.500000 17343.7500 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 37 37.000000 1850.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 234 839.500000 53324.3300 63.5192
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 87 88.250000 4412.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 59 74.750000 3737.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 26 31.000000 1550.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 38.000000 1900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 61 99.000000 4950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 98 143.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 187 1048.500000 52135.0000 49.7234
INTR-T1013-INTERPRETER 3 32.250000 1612.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 351 1960.000000 19600.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 139.250000 9948.0200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 11 34.500000 2464.6800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 23.000000 1314.6800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 86 369.250000 26379.2200 71.4400
TRAV-TRAVS-Travel by mile 367 26050.00000 11595.1200 0.4451
Subtotal (Total Children Is Unduplicated) 446 30133.50000 141667.9700 4.7013
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Total 33536.500000 282441.8000 8.4219
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Number of Children (Unduplicated) With at Least One Service 915
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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 2910 2655.250000 127227.4300 124562.7300
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 3365 28464.500000 73508.1100 62118.8500
3173 2000.500000 57603.4600 140.8900
Other 0 0.000000 0.0000 0.0000
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Total 9815 33536.500000 282441.8000 186859.4700