CMS/EIP Fiscal Report Center: 57
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 244 100.750000 3727.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 37 27.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1342 4177.500000 154567.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1350 4306.000000 158295.2500 36.7616
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 102 183.000000 9150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 2.500000 168.0000 67.2000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 11.500000 638.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 218 180.000000 13500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 21.000000 1575.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 304 284.500000 15789.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 99 93.000000 6975.0000 75.0000
Subtotal (Total Children Is Unduplicated) 439 784.000000 48433.5000 61.7774
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 68.000000 1700.0000 25.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 4.000000 285.7600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.750000 267.9000 71.4400
Subtotal (Total Children Is Unduplicated) 1 75.750000 2253.6600 29.7513
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Total 5165.750000 208982.4100 40.4554
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Number of Children (Unduplicated) With at Least One Service 1390
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Center 57
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 2431 2486.750000 99109.7500 0.0000
P 242 207.750000 9475.2500 9475.3000
D 15 20.250000 805.7500 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
2506 2451.000000 99591.6600 2253.6600
Other 0 0.000000 0.0000 0.0000
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Total 5194 5165.750000 208982.4100 11728.9600