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
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
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 31 58.000000 3490.6500 60.1836
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 155 177.000000 8850.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 104 158.000000 7900.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 11.000000 275.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 88 140.500000 7025.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 30 32.750000 1637.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 5 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 50 60.500000 3025.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 122 183.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 21 83.000000 4150.0000 50.0000
INTR-T1013-INTERPRETER 2 13.000000 650.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 641 4976.000000 49740.0000 9.9960
OCCT-97530-OT SESSION BY LICENSED OT 54 225.750000 16127.5800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 21 144.750000 8279.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 29 133.000000 9401.5200 70.6881
PHY-97110HM-PT SESSION BY PT ASST 1 5.750000 328.6700 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 56 340.500000 24325.3200 71.4400
TRAV-TRAVS-Travel by mile 543 48158.00000 21434.4700 0.4451
Subtotal (Total Children Is Unduplicated) 745 54848.00000 163287.2600 2.9771
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Total 56217.250000 207894.1600 3.6980
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Number of Children (Unduplicated) With at Least One Service 985
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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 3 55.250000 78.5000 78.5000
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 5938 54511.250000 164083.1200 160536.4000
2932 1646.750000 43510.5400 197.2900
Other 0 0.000000 0.0000 0.0000
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Total 8875 56217.250000 207894.1600 160812.1900