CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 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 788 1180.250000 43650.7500 36.9843
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 528 585.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 930 2346.750000 86690.5000 36.9407
Subtotal (Total Children Is Unduplicated) 1072 4112.000000 130341.2500 31.6978
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 5 6.500000 325.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 24.000000 1800.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.500000 1087.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 24.500000 1351.5000 55.1633
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 64.000000 4800.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 19.000000 1425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 22.000000 1650.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 83 143.999999 7964.2500 55.3073
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 75 142.000000 10575.0000 74.4718
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 170 467.499999 31478.2500 67.3332
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 29 23.500000 1175.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 215 264.500000 13218.7500 49.9764
CONIP-CONIP-CONSULT, ITDS PHONE 14 6.250000 156.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 102 54.500000 2712.5000 49.7706
CONOP-CONOP-CONSULT, OT, PHONE 29 17.750000 443.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 153 103.500000 5125.0000 49.5169
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 177 136.000000 6800.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 3.500000 87.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 11 26.000000 1906.3200 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 564 1774.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 32.000000 800.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 291 1168.250000 58412.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 623 3174.000000 31710.0000 9.9905
OCCT-97530-OT SESSION BY LICENSED OT 24 112.000000 7930.0800 70.8043
OCCT-97530HM-OT SESSION BY OT ASST 3 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 49 249.000000 17777.8600 71.3970
PHY-97110HM-PT SESSION BY PT ASST 12 22.000000 1257.5200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 58 237.250000 16602.7600 69.9800
SPL-92508-GROUP SPL SESSION PER CHILD 7 11.000000 152.6800 13.8800
Subtotal (Total Children Is Unduplicated) 627 7421.500000 166541.0200 22.4403
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Total 12000.999999 328360.5200 27.3611
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Number of Children (Unduplicated) With at Least One Service 1167
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Center 53
Flag Claims Units Chgs Paid
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R 7 8.250000 381.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1234 1166.000000 54255.2400 118.5000
P 1649 1506.028672 69328.8600 68824.0000
D 47 48.585585 2507.0200 0.0000
S 55 46.000000 1655.7500 1563.2500
H 2 1.500000 107.1600 0.0000
T 0 0.000000 0.0000 0.0000
11505 9172.135742 197116.0900 0.0000
Other 46 52.500000 3009.1500 0.0000
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Total 14545 12000.999999 328360.5200 70505.7500