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
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 797 1111.000000 41071.0000 36.9676
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 621 736.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 316 827.500000 30599.0000 36.9776
Subtotal (Total Children Is Unduplicated) 1004 2674.750000 71670.0000 26.7950
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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 3 2.250000 112.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 4.500000 337.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 14.500000 1087.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 43.000000 2386.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 37.000000 2775.0000 75.0000
Subtotal (Total Children Is Unduplicated) 43 118.250000 7869.5000 66.5497
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 36 24.750000 1237.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 312 590.000000 29500.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 25 14.500000 362.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 3.250000 162.5000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 8 16.000000 1173.1200 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 554 1913.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 14.750000 368.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 59 183.325000 9153.2500 49.9291
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 608 3619.000000 36171.0000 9.9947
Subtotal (Total Children Is Unduplicated) 611 6379.325000 78128.6200 12.2472
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Total 9172.325000 157668.1200 17.1895
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Number of Children (Unduplicated) With at Least One Service 1076
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Center 53
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 17 15.500000 573.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11906 9152.825000 156894.6200 0.0000
Other 4 4.000000 200.0000 0.0000
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Total 11927 9172.325000 157668.1200 0.0000