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
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 867 793.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2000 7061.000000 261072.0000 36.9738
Subtotal (Total Children Is Unduplicated) 2173 12163.00000 420458.7500 34.5687
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 141 280.500000 14025.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 415.1100 59.3014
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 255 418.500000 30532.9200 72.9580
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 119 201.000000 14612.9500 72.7012
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 142 251.000000 18658.1900 74.3354
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 305 534.000000 28911.8800 54.1421
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 167 263.500000 19194.1000 72.8429
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 19.000000 950.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 7 45.000000 2250.0000 50.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 12 12.000000 542.6000 45.2167
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 97.8800 48.9400
Subtotal (Total Children Is Unduplicated) 657 2069.000000 132635.8800 64.1063
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 165 262.250000 13112.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 48 49.000000 1225.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 20 28.500000 1425.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 24 26.000000 1300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 40.750000 2037.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 42 47.750000 2387.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 249 314.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1277 9033.000000 449020.5600 49.7089
INTR-T1013-INTERPRETER 80 227.750000 10625.5000 46.6542
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 117 796.000000 7960.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 139 1055.500000 73789.3500 69.9094
PHY-97110-PT SESSION BY LICENSED PT 209 1801.000000 126197.6600 70.0709
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 497 4232.500000 294434.0300 69.5650
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 1647 162011.0000 71484.9300 0.4412
Subtotal (Total Children Is Unduplicated) 1828 179934.7500 1055180.0500 5.8642
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Total 194166.750000 1608274.6800 8.2830
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Number of Children (Unduplicated) With at Least One Service 2284
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Center 09
Flag Claims Units Chgs Paid
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R 189 222.750000 8241.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1701 1600.750000 62626.5000 124.5000
P 21682 169142.250000 1003762.2800 1003774.1700
D 11 11.000000 785.8400 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
3488 22881.000000 510228.3100 0.0000
Other 183 309.000000 22630.0000 0.0000
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Total 27254 194166.750000 1608274.6800 1003898.6700