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
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 960 1535.000000 56776.5000 36.9879
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 628 680.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 287 695.500000 25724.2500 36.9867
Subtotal (Total Children Is Unduplicated) 1118 2911.000000 82500.7500 28.3410
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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 1 0.500000 37.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
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 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 12.000000 666.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
SCREEN-T1023-SCREENING 4 5.000000 250.0000 50.0000
Subtotal (Total Children Is Unduplicated) 23 45.000000 2941.0000 65.3556
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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 5 11.750000 293.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 13 58.750000 2937.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 615 3288.000000 32870.0000 9.9970
OCCT-97530-OT SESSION BY LICENSED OT 2 3.000000 214.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 16.000000 1143.0400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 20.000000 1407.3600 70.3680
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 631 5804.750000 65436.8500 11.2730
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Total 8760.750000 150878.6000 17.2221
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Number of Children (Unduplicated) With at Least One Service 1203
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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 1 1.000000 37.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 10 9.750000 427.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 8 5.000000 76.2500 76.2500
11681 8745.000000 150337.8500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11700 8760.750000 150878.6000 76.2500