CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
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 882 985.750000 36472.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 317 291.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1029 3785.250000 140054.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1086 5062.750000 176527.0000 34.8678
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 6 12.000000 600.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 10 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 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 124 250.000000 18750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 73 145.500000 10912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 59 117.266667 8795.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 36.000000 1998.0000 55.5000
OCTF-97168-OT RE-EVAL EST PLAN CARE 9 9.000000 459.4500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 17 17.000000 867.8500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 19 19.000000 969.9500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 221 658.766667 46475.8500 70.5498
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 7.000000 1394.2400 199.1771
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 6.000000 300.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 70 71.750000 3587.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 39 91.750000 2293.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 25 25.000000 1250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 21 43.500000 1087.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 5.000000 250.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 63 63.750000 3187.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 23 53.250000 1331.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 26.000000 650.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 328 1784.000000 89200.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 693 7076.000000 70760.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 161 940.502400 67189.3200 71.4398
OCCT-97530HM-OT SESSION BY OT ASST 166 1073.000400 61375.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 109 637.750000 45525.1400 71.3840
PHY-97110HM-PT SESSION BY PT ASST 73 464.500000 26550.8200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 299 2189.800714 156381.7601 71.4137
SPL-92508-GROUP SPL SESSION PER CHILD 4 12.000000 166.5600 13.8800
TRAV-TRAVS-Travel by mile 158 9216.000000 4102.3900 0.4451
Subtotal (Total Children Is Unduplicated) 754 23787.55351 536633.3301 22.5594
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Total 29509.070181 759636.1801 25.7425
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Number of Children (Unduplicated) With at Least One Service 1088
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Center 55
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 2 0.750000 27.7500 0.0000
P 11376 16117.636870 310791.9201 310791.9200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 3467 6476.016431 91345.5300 91345.5300
9109 6912.666880 357320.9800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 23955 29509.070181 759636.1801 402137.4500