CMS/EIP Fiscal Report Center: 54
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 673 400.000000 14772.2500 36.9306
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 741 933.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1415 4149.250000 152837.7500 36.8350
Subtotal (Total Children Is Unduplicated) 1449 5482.750000 167610.0000 30.5704
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 7.000000 339.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 24 38.000000 1900.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 47.500000 3562.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 16.500000 1237.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 30.000000 2250.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 151 259.500000 19387.5000 74.7110
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 60.000000 4500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 58 83.500000 4634.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 50 82.000000 6112.5000 74.5427
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
Subtotal (Total Children Is Unduplicated) 288 651.000000 45681.7500 70.1717
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 35 35.750000 1787.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 470 429.500000 21425.0000 49.8836
CONIP-CONIP-CONSULT, ITDS PHONE 6 1.750000 43.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 20.000000 1000.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 5.000000 366.6000 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 578 1702.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 287 1513.500000 75662.5000 49.9917
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 687 2932.000000 29310.0000 9.9966
OCCT-97530-OT SESSION BY LICENSED OT 3 9.000000 642.9600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 8 20.000000 1428.8000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 67.000000 4786.4800 71.4400
Subtotal (Total Children Is Unduplicated) 742 6737.750000 136491.0900 20.2577
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Total 12871.500000 349782.8400 27.1750
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Number of Children (Unduplicated) With at Least One Service 1459
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Center 54
Flag Claims Units Chgs Paid
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R 1385 1119.750000 47042.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3048 2463.750000 108226.8500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 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
12111 9288.000000 194513.7400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 16544 12871.500000 349782.8400 0.0000