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
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 787 1177.500000 43549.0000 36.9843
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 527 582.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 266 707.250000 26167.7500 36.9993
Subtotal (Total Children Is Unduplicated) 951 2467.250000 69716.7500 28.2569
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 4 5.500000 275.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.000000 555.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
Subtotal (Total Children Is Unduplicated) 20 42.500000 2855.0000 67.1765
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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 177 135.000000 6750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 3.500000 87.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 9.000000 659.8800 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 564 1773.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 72.750000 3637.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 623 3173.000000 31700.0000 9.9905
OCCT-97530-OT SESSION BY LICENSED OT 1 8.000000 571.5200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 26.000000 1814.5600 69.7908
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 627 5680.250000 68273.7200 12.0195
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Total 8190.000000 140845.4700 17.1972
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Number of Children (Unduplicated) With at Least One Service 1084
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Center 53
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 1 1.000000 50.0000 50.0000
D 10 15.500000 725.5000 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
10518 8173.500000 140069.9700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10529 8190.000000 140845.4700 50.0000