CMS/EIP Fiscal Report Center: 53
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 836 1122.500000 41532.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 562 644.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 934 2512.500000 92768.7500 36.9229
Subtotal (Total Children Is Unduplicated) 1093 4279.000000 134301.2500 31.3861
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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 7 7.250000 362.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 45.000000 3375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 38.000000 2850.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 17.000000 1275.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 26.500000 1470.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 59.000000 4425.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 45.000000 3375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 29.500000 2212.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 112 191.500000 10628.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 94 171.500000 12825.0000 74.7813
Subtotal (Total Children Is Unduplicated) 239 633.750000 43035.0000 67.9053
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 19 14.250000 712.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 249 281.250000 14062.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 15 5.500000 131.5000 23.9091
CONOF-CONOF-CONSULT, OT, FACE TO FACE 166 104.000000 5187.5000 49.8798
CONOP-CONOP-CONSULT, OT, PHONE 18 7.250000 181.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 143 93.250000 4650.0000 49.8660
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 81 54.250000 2712.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 2.000000 50.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 22.000000 1613.0400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 604 1854.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 31.000000 775.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 370 1921.000000 96050.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 656 3442.000000 34410.0000 9.9971
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
Subtotal (Total Children Is Unduplicated) 663 7834.750000 160638.4800 20.5033
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Total 12747.500000 337974.7300 26.5130
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Number of Children (Unduplicated) With at Least One Service 1148
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Center 53
Flag Claims Units Chgs Paid
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R 21 18.500000 739.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 773 715.500000 29755.7500 2.0000
P 2700 2714.320600 127242.2800 127349.4200
D 1 1.000000 73.3200 0.0000
S 17 17.750000 720.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11717 9051.929400 166717.4100 0.0000
Other 201 228.500000 12725.9700 0.0000
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Total 15430 12747.500000 337974.7300 127351.4200