CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 481 215.500000 7899.5000 36.6566
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 702 668.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2516 5901.000000 217957.7500 36.9357
Subtotal (Total Children Is Unduplicated) 2553 6785.000000 225857.2500 33.2877
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 8 13.500000 675.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 22.500000 1687.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 78 124.000000 6882.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 263 457.000000 34236.0000 74.9147
Subtotal (Total Children Is Unduplicated) 321 628.000000 44159.2500 70.3173
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 10 11.500000 575.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 7 7.000000 350.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.500000 25.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 8.000000 400.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 86 312.250000 15612.5000 50.0000
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 3.000000 30.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 27.000000 1928.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 29 82.000000 5858.0800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 2 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 67.000000 4786.4800 71.4400
Subtotal (Total Children Is Unduplicated) 158 529.250000 30087.4200 56.8492
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Total 7942.250000 300103.9200 37.7858
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Number of Children (Unduplicated) With at Least One Service 2582
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Center 01
Flag Claims Units Chgs Paid
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R 600 432.250000 17890.0900 0.0000
U 0 0.000000 0.0000 0.0000
B 701 770.000000 46457.8700 0.0000
P 6007 3810.750000 140696.2500 140560.7000
D 15 9.500000 385.9400 0.0000
S 8 8.250000 429.0000 0.0000
H 149 188.000000 13565.9100 37.0000
T 2 1.750000 77.7500 50.0000
4221 2714.250000 80058.1100 0.0000
Other 5 7.500000 543.0000 0.0000
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Total 11708 7942.250000 300103.9200 140647.7000