CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 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 2183 5294.250000 195785.5000 36.9808
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1628 2813.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2318 10366.00000 382876.0000 36.9358
Subtotal (Total Children Is Unduplicated) 2515 18474.00000 578661.5000 31.3230
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 3.000000 145.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 18 18.750000 937.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 55 124.500033 9337.5025 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 41 96.000000 7200.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 32 63.500000 4762.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 46 86.500000 4792.5000 55.4046
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 143 250.000000 18750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 65 111.000000 8325.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 85 130.500000 9750.0000 74.7126
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 396 674.576304 37328.9850 55.3369
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 360 661.500000 49425.0000 74.7166
SCREEN-T1023-SCREENING 5 8.000000 400.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 811 2234.826337 151655.5375 67.8601
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 93 82.750000 4075.7500 49.2538
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 6.750000 168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 652 1105.000000 55193.7500 49.9491
CONIP-CONIP-CONSULT, ITDS PHONE 69 27.750000 687.7500 24.7838
CONOF-CONOF-CONSULT, OT, FACE TO FACE 409 348.000000 17337.5000 49.8204
CONOP-CONOP-CONSULT, OT, PHONE 61 32.500000 812.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 413 385.250000 19200.0000 49.8378
CONPP-CONPP-CONSULT, PT, PHONE 2 2.500000 62.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 400 357.000000 17850.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 31 12.500000 312.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 20 97.000000 7112.0400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1235 7587.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 54 113.250000 2831.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 619 6335.749040 316712.4520 49.9882
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1300 13835.00000 138300.0000 9.9964
OCCT-97530-OT SESSION BY LICENSED OT 44 259.000000 18353.2000 70.8618
OCCT-97530HM-OT SESSION BY OT ASST 3 6.000000 343.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 68 606.250000 43271.2400 71.3752
PHY-97110HM-PT SESSION BY PT ASST 6 10.000000 571.6000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 80 617.000000 43895.4600 71.1434
SPL-92508-GROUP SPL SESSION PER CHILD 9 11.250000 156.1500 13.8800
Subtotal (Total Children Is Unduplicated) 1313 31837.74904 687247.5920 21.5859
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Total 52546.575377 1417564.6295 26.9773
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Number of Children (Unduplicated) With at Least One Service 2529
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Center 53
Flag Claims Units Chgs Paid
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R 10 9.250000 428.9300 0.0000
U 0 0.000000 0.0000 0.0000
B 4403 3989.500000 182591.9700 218.8800
P 10822 10271.693300 476288.8651 477856.8100
D 231 232.079585 12898.6300 0.0000
S 155 147.500000 6806.2300 5419.2700
H 22 24.000000 1689.8000 0.0000
T 26 16.750000 215.5000 206.2500
47995 36831.052492 673277.7944 50.0000
Other 933 1024.750000 63366.9100 0.0000
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Total 64597 52546.575377 1417564.6295 483751.2100