CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2018 ending 06/30/2018 Date of Report:08/10/2018 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 797 1111.000000 41071.0000 36.9676
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 621 736.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1001 2680.500000 99132.2500 36.9827
Subtotal (Total Children Is Unduplicated) 1102 4527.750000 140203.2500 30.9653
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 5 4.250000 212.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 19.500000 1462.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 19 44.000000 3300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 60.000000 3330.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 37 61.000000 4575.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 47.500000 3562.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 18.000000 1350.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 159 274.000000 15207.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 138 246.500000 18487.5000 75.0000
NURS-T1001-NURSING ASSESSMENT 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 240 794.250000 52898.0000 66.6012
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 872.9400 218.2350
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 53 38.250000 1912.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 324 889.000000 44450.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 29 15.500000 387.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 3.250000 162.5000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 20.000000 1466.4000 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 554 1913.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 24 41.750000 1043.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 711 4235.500000 211762.0000 49.9969
INTR-T1013-INTERPRETER 3 10.000000 620.0000 62.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 810 7063.000000 70611.0000 9.9973
OCCT-97530-OT SESSION BY LICENSED OT 15 108.459991 7748.3814 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 4 12.000000 686.4000 57.2000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 31.000000 2214.6400 71.4400
TRAV-TRAVS-Travel by mile 509 53688.00000 23897.2100 0.4451
Subtotal (Total Children Is Unduplicated) 813 68074.70999 367866.4714 5.4039
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Total 73396.709991 560967.7214 7.6430
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Number of Children (Unduplicated) With at Least One Service 1180
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Center 53
Flag Claims Units Chgs Paid
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R 2 1.500000 68.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 16 13.500000 647.5000 0.0000
P 3870 3534.306600 159242.5800 158769.4100
D 0 0.000000 0.0000 0.0000
S 27 23.500000 972.5000 0.0000
H 2643 20318.851483 36395.3500 36395.3500
T 2085 13253.000000 26561.3300 26561.3300
17057 36104.051908 328678.7114 0.0000
Other 123 148.000000 8401.2500 0.0000
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Total 25823 73396.709991 560967.7214 221726.0900