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
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 6 10.500000 388.5000 37.0000
Subtotal (Total Children Is Unduplicated) 6 10.500000 388.5000 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 96.500000 6241.2700 64.6764
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 66.500000 4577.3900 68.8329
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 17.000000 1215.2900 71.4876
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 61 119.000000 6624.2500 55.6660
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 11 11.000000 550.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 84 329.000000 20317.4000 61.7550
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2 1.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 46 261.000000 12910.0000 49.4636
OCCT-97530-OT SESSION BY LICENSED OT 8 46.250000 3304.1000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 4 9.250000 660.8200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 190.250000 13591.4600 71.4400
TRAV-TRAVS-Travel by mile 1 22.000000 9.7900 0.4450
Subtotal (Total Children Is Unduplicated) 91 529.750000 30476.1700 57.5293
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Total 869.250000 51182.0700 58.8807
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Number of Children (Unduplicated) With at Least One Service 159
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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 5 4.000000 148.0000 0.0000
P 74 88.750000 5944.6800 4588.1800
D 71 95.000000 5030.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 69 106.250000 7090.6100 0.0000
T 409 455.000000 26110.9600 17596.2400
108 120.250000 6857.8200 20.0000
Other 0 0.000000 0.0000 0.0000
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Total 736 869.250000 51182.0700 22204.4200