CMS/EIP Fiscal Report Center: 53
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 69 100.250000 3709.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 86 126.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 101 408.250000 15105.2500 37.0000
Subtotal (Total Children Is Unduplicated) 104 635.250000 18814.5000 29.6175
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 450.0000 81.8182
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 70 109.000000 6049.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 70 110.500000 8287.5000 75.0000
Subtotal (Total Children Is Unduplicated) 81 246.000000 16235.2500 65.9970
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 5.500000 275.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 65 87.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 21.000000 1050.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 85 198.000000 1980.0000 10.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 214.3200 71.4400
TRAV-TRAVS-Travel by mile 34 988.000000 439.8100 0.4452
Subtotal (Total Children Is Unduplicated) 86 1302.500000 3959.1300 3.0396
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Total 2183.750000 39008.8800 17.8633
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Number of Children (Unduplicated) With at Least One Service 105
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Center 53
Flag Claims Units Chgs Paid
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R 101 102.250000 4699.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 24 22.000000 898.7500 0.0000
P 129 161.160810 8226.5700 7867.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 81 586.750000 826.1500 826.1500
T 40 441.500000 571.0600 571.0600
912 865.839190 23517.1000 0.0000
Other 3 4.250000 270.2500 0.0000
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Total 1290 2183.750000 39008.8800 9264.4600