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:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 126 442.500000 16372.5000 37.0000
Subtotal (Total Children Is Unduplicated) 126 442.500000 16372.5000 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 11 22.000000 1100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 35.000000 2567.8800 73.3680
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 35.500000 2662.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 30.000000 1656.7500 55.2250
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
Subtotal (Total Children Is Unduplicated) 36 131.500000 8623.1300 65.5751
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 52 46.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 31.000000 1550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 21.4400 21.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 62.000000 4414.2800 71.1981
Subtotal (Total Children Is Unduplicated) 59 140.500000 5985.7200 42.6030
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Total 714.500000 30981.3500 43.3609
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Number of Children (Unduplicated) With at Least One Service 211
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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 234 183.500000 8564.7200 8564.7200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 47 88.500000 6044.1300 0.0000
T 0 0.000000 0.0000 0.0000
455 442.500000 16372.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 736 714.500000 30981.3500 8564.7200