CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2019 ending 06/30/2019 Date of Report:07/21/2019 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 960 1535.000000 56776.5000 36.9879
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 628 680.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1084 2621.250000 96773.5000 36.9188
Subtotal (Total Children Is Unduplicated) 1239 4836.750000 153550.0000 31.7465
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 4 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 16.000000 888.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 42 73.000000 5475.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 35.500000 2662.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 46.000000 3412.5000 74.1848
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 160.000000 8797.7500 54.9859
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 80 150.500000 11212.5000 74.5017
SCREEN-T1023-SCREENING 5 7.000000 350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 210 526.000000 35549.3000 67.5842
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 24 21.750000 1050.7500 48.3103
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 214 226.500000 11312.5000 49.9448
CONIP-CONIP-CONSULT, ITDS PHONE 23 8.250000 206.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 122 91.500000 4550.0000 49.7268
CONOP-CONOP-CONSULT, OT, PHONE 4 1.250000 31.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 136 85.500000 4275.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 145 99.000000 4950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 11 6.000000 150.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 575 1865.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 22 37.000000 925.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 249 1144.250000 57212.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 615 3288.000000 32870.0000 9.9970
OCCT-97530-OT SESSION BY LICENSED OT 37 145.000000 10280.2400 70.8982
OCCT-97530HM-OT SESSION BY OT ASST 2 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 56 345.250000 24650.3800 71.3986
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 67 372.250000 26532.4000 71.2758
SPL-92508-GROUP SPL SESSION PER CHILD 4 4.250000 58.9900 13.8800
Subtotal (Total Children Is Unduplicated) 631 7745.250000 179258.0700 23.1443
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Total 13108.000000 368357.3700 28.1017
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Number of Children (Unduplicated) With at Least One Service 1293
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Center 53
Flag Claims Units Chgs Paid
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R 9 8.250000 378.9300 0.0000
U 0 0.000000 0.0000 0.0000
B 2709 2458.500000 116191.8400 18.5000
P 1086 1007.000000 48197.1000 48085.8000
D 45 41.750000 2386.4000 0.0000
S 40 40.000000 1697.4600 1411.7000
H 14 16.000000 1118.2800 0.0000
T 9 5.250000 85.5000 76.2500
12089 9146.000000 173523.2600 0.0000
Other 357 385.250000 24778.6000 0.0000
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Total 16358 13108.000000 368357.3700 49592.2500