CMS/EIP Fiscal Report Center: 09
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
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 1832 4309.000000 159386.7500 36.9893
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 795 738.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 816 2819.750000 104321.5000 36.9967
Subtotal (Total Children Is Unduplicated) 2005 7867.000000 263708.2500 33.5208
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 136 270.500000 13525.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 30.000000 2250.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 16.500000 1237.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 30.000000 1665.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 17.500000 1312.5000 75.0000
Subtotal (Total Children Is Unduplicated) 178 367.500000 20185.7500 54.9272
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 22 31.500000 1575.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 5.250000 131.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 7.000000 350.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 7.000000 350.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 249 314.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 67.000000 3350.0000 50.0000
INTR-T1013-INTERPRETER 77 142.750000 7137.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 13.000000 928.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 23.000000 1643.1200 71.4400
Subtotal (Total Children Is Unduplicated) 327 612.250000 15515.5900 25.3419
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Total 8846.750000 299409.5900 33.8440
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Number of Children (Unduplicated) With at Least One Service 2044
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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 10983 8779.500000 296827.5900 296827.5900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
74 67.250000 2582.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11057 8846.750000 299409.5900 296827.5900