CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2017 ending 06/30/2018 Date of Report:08/10/2018 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 1848 4250.000000 157093.7500 36.9632
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1618 3755.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2116 10282.25000 379917.0000 36.9488
Subtotal (Total Children Is Unduplicated) 2284 18288.00000 537010.7500 29.3641
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 7.000000 339.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 12 11.000000 550.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 56 131.500000 9862.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 41 94.000000 7050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 29 56.000000 4200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 84.000000 4662.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 96 169.000000 12600.0000 74.5562
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 74.000000 5550.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 34 56.500000 4237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 323 550.500000 30547.2500 55.4900
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 419 760.499970 56999.9978 74.9507
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 729 2003.499970 137263.3478 68.5118
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 151 166.500000 8325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 730 2227.500000 111231.2500 49.9355
CONIP-CONIP-CONSULT, ITDS PHONE 101 57.250000 1431.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 3.250000 162.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 0.500000 25.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.250000 31.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 23 62.000000 4545.8400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1015 6087.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 39 71.750000 1793.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 634 6975.000000 348749.5000 49.9999
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1215 13135.00000 131311.0000 9.9970
OCCT-97530-OT SESSION BY LICENSED OT 3 15.000000 1071.6000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 5 22.000000 1571.6800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 27.000000 1928.8800 71.4400
TRAV-TRAVS-Travel by mile 2 41.000000 18.2500 0.4451
Subtotal (Total Children Is Unduplicated) 1218 28900.00000 612466.4100 21.1926
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Total 49191.499970 1286740.5078 26.1578
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Number of Children (Unduplicated) With at Least One Service 2288
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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 329 214.750000 8097.5000 0.0000
P 14153 13283.568900 600021.3027 588129.2800
D 5 7.000000 467.1900 0.0000
S 30 26.500000 1083.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
45423 35250.431070 653446.8851 50.0000
Other 333 407.750000 23555.6300 0.0000
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Total 60275 49191.499970 1286740.5078 588179.2800