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
Payclass Filters:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 864 1192.500000 44086.5000 36.9698
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 702 903.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 349 967.750000 35788.2500 36.9809
Subtotal (Total Children Is Unduplicated) 1094 3063.250000 79874.7500 26.0752
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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 5 4.250000 212.5000 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 11 10.000000 750.0000 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 8 13.500000 749.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 20.000000 1500.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.000000 825.0000 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 43 75.500000 4190.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 61.000000 4575.0000 75.0000
Subtotal (Total Children Is Unduplicated) 76 206.750000 13638.0000 65.9637
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 510.3900 170.1300
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 53 38.250000 1912.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 324 889.000000 44450.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 29 15.500000 387.5000 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 624 1986.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 18.750000 468.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 104 422.764000 21125.2000 49.9693
INTR-T1013-INTERPRETER 2 9.000000 570.0000 63.3333
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 886 7217.000000 72151.0000 9.9974
OCCT-97530-OT SESSION BY LICENSED OT 7 16.036813 1145.6700 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 31.000000 2214.6400 71.4400
TRAV-TRAVS-Travel by mile 535 54305.00000 24171.8500 0.4451
Subtotal (Total Children Is Unduplicated) 889 64972.55081 170474.3700 2.6238
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Total 68242.550813 263987.1200 3.8684
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Number of Children (Unduplicated) With at Least One Service 1237
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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 19 17.750000 656.7500 0.0000
H 2629 20389.851483 34486.5100 34486.5100
T 2105 13626.500000 26347.5100 26347.5100
15111 34204.449330 202296.3500 0.0000
Other 4 4.000000 200.0000 0.0000
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Total 19868 68242.550813 263987.1200 60834.0200