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
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 712 1134.000000 41930.2500 36.9755
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 594 673.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 890 2583.000000 95303.7500 36.8965
Subtotal (Total Children Is Unduplicated) 1025 4390.500000 137234.0000 31.2570
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 3 3.250000 162.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 38.000000 2850.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 25.500000 1912.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 27.000000 2025.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 19.500000 1462.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 15.500000 1162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 79 131.500000 7298.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 118 204.000000 15300.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 191 495.750000 34185.6000 68.9573
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 59 52.500000 2625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 3.000000 75.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 290 526.250000 26225.0000 49.8337
CONIP-CONIP-CONSULT, ITDS PHONE 39 16.500000 412.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 9.000000 659.8800 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 521 1743.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 14.000000 350.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 330 1692.500000 84625.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 571 3048.000000 30470.0000 9.9967
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 142.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 7.000000 500.0800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 7.000000 500.0800 71.4400
Subtotal (Total Children Is Unduplicated) 583 7120.750000 146585.4200 20.5857
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Total 12007.000000 318005.0200 26.4850
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Number of Children (Unduplicated) With at Least One Service 1065
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Center 53
Flag Claims Units Chgs Paid
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R 947 870.500000 38154.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 214 153.250000 6103.0000 0.0000
P 1573 1571.673380 71166.2998 70261.3700
D 4 5.000000 295.7500 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
11711 9386.076620 201145.8402 0.0000
Other 17 20.500000 1139.6300 0.0000
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Total 14466 12007.000000 318005.0200 70261.3700