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
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 136 270.500000 13525.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 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 177 280.500000 20182.9200 71.9534
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 19 32.500000 2437.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 270 475.000000 25637.3800 53.9734
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 68 112.000000 7908.6000 70.6125
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 440.5000 44.0500
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) 609 1409.500000 86599.4300 61.4398
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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 58 256.000000 12800.0000 50.0000
INTR-T1013-INTERPRETER 77 142.750000 7137.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 106.000000 7453.7100 70.3180
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 174.000000 11685.4900 67.1580
Subtotal (Total Children Is Unduplicated) 327 1045.250000 41532.9500 39.7349
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Total 14617.750000 548591.1300 37.5291
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Number of Children (Unduplicated) With at Least One Service 2191
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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 1700 1599.250000 62514.0000 124.5000
P 14395 12439.250000 456566.2800 456578.1700
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
288 344.500000 20446.2600 0.0000
Other 1 1.000000 37.0000 0.0000
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Total 16584 14617.750000 548591.1300 456702.6700