CMS/EIP Fiscal Report Center: 52
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 524 280.000000 10341.5000 36.9339
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 290 188.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 312 843.250000 30774.7500 36.4954
Subtotal (Total Children Is Unduplicated) 784 1311.250000 41116.2500 31.3565
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 7 7.000000 350.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 19 35.000000 2194.0000 62.6857
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 77 72.250000 3612.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 57 62.250000 3112.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 14.250000 712.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 11.750000 587.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 34.500000 1725.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 122 183.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 29.000000 1450.0000 50.0000
INTR-T1013-INTERPRETER 2 13.000000 650.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 267 1526.000000 15260.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 24.750000 1768.1400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 2.000000 142.8800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 30.000000 2143.2000 71.4400
TRAV-TRAVS-Travel by mile 346 23202.00000 10327.4700 0.4451
Subtotal (Total Children Is Unduplicated) 445 25207.00000 41547.9400 1.6483
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Total 26553.250000 84858.1900 3.1958
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Number of Children (Unduplicated) With at Least One Service 903
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Center 52
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 2 4.000000 222.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2697 24964.000000 41273.3500 37721.6300
2926 1585.250000 43362.8400 49.5900
Other 0 0.000000 0.0000 0.0000
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Total 5625 26553.250000 84858.1900 37771.2200