CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 1597 4054.000000 149998.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 689 624.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 697 2596.250000 96042.7500 36.9929
Subtotal (Total Children Is Unduplicated) 1728 7274.750000 246040.7500 33.8212
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 119 241.000000 12050.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 14.000000 1050.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 21.500000 1193.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.000000 600.0000 75.0000
Subtotal (Total Children Is Unduplicated) 146 298.000000 15905.7500 53.3750
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 29 34.250000 1712.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 10.000000 500.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 8.000000 400.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 224 278.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 113.000000 5650.0000 50.0000
INTR-T1013-INTERPRETER 112 231.750000 11587.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 3.000000 214.3200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 260.7600 65.1900
Subtotal (Total Children Is Unduplicated) 333 685.500000 20487.5800 29.8871
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Total 8258.250000 282434.0800 34.2002
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Number of Children (Unduplicated) With at Least One Service 1763
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Center 09
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 0 0.000000 0.0000 0.0000
P 9771 8230.500000 281425.8300 281425.8300
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
35 27.750000 1008.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9806 8258.250000 282434.0800 281425.8300