CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 Page: 1
List order: No List
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 1576 986.750000 36509.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 849 666.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2127 5277.000000 195227.2500 36.9959
Subtotal (Total Children Is Unduplicated) 2292 6929.750000 231737.0000 33.4409
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 36 66.500000 3285.0000 49.3985
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.500000 249.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 225 370.000000 26793.3000 72.4143
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 122 205.000000 15375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 320 532.500000 29109.7500 54.6662
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 100 156.500000 11737.5000 75.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 83.2900 83.2900
Subtotal (Total Children Is Unduplicated) 428 1353.500000 87946.0900 64.9768
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 117 113.250000 5637.5000 49.7792
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 9.000000 225.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 20 18.500000 912.5000 49.3243
CONIP-CONIP-CONSULT, ITDS PHONE 20 20.250000 506.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 3.500000 87.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 3.000000 150.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 5 4.500000 112.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 16.500000 812.5000 49.2424
CONSP-CONSP-CONSULT, SLP, PHONE 15 15.750000 393.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1107 8640.250000 430812.5000 49.8611
INTR-T1013-INTERPRETER 15 48.000000 2760.0000 57.5000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1408 12134.00000 121080.0000 9.9786
OCCT-97530-OT SESSION BY LICENSED OT 116 446.250000 31339.0100 70.2275
OCCT-97530HM-OT SESSION BY OT ASST 39 164.750000 9371.7400 56.8846
PHY-97110-PT SESSION BY LICENSED PT 72 395.500000 26223.6300 66.3050
PHY-97110HM-PT SESSION BY PT ASST 1 0.500000 3.5800 7.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 269 1353.000000 90755.5700 67.0773
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 1447 23390.50000 721311.2900 30.8378
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Total 31673.750000 1040994.3800 32.8662
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Number of Children (Unduplicated) With at Least One Service 2434
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Center 06
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 11016 10457.250000 234818.0100 234818.0100
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
26750 21216.500000 806176.3700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 37766 31673.750000 1040994.3800 234818.0100