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
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 2182 5291.500000 195683.7500 36.9808
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1627 2811.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 730 2909.750000 107595.5000 36.9776
Subtotal (Total Children Is Unduplicated) 2394 11012.50000 303279.2500 27.5395
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 17 17.750000 887.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 32.000000 2400.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 17 21.000000 1575.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.500000 1312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 46.500000 2580.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 47.000000 3525.0000 75.0000
SCREEN-T1023-SCREENING 4 6.000000 300.0000 50.0000
Subtotal (Total Children Is Unduplicated) 100 211.250000 14199.7500 67.2178
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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 400 356.000000 17800.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 31 12.500000 312.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 17 76.000000 5572.3200 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1235 7585.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 32.750000 818.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 64 311.580400 15579.0200 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1300 13834.00000 138290.0000 9.9964
OCCT-97530-OT SESSION BY LICENSED OT 3 11.000000 785.8400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 22.000000 1571.6800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 46.000000 3221.9200 70.0417
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.000000 41.6400 13.8800
Subtotal (Total Children Is Unduplicated) 1313 24282.08040 281589.3300 11.5966
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Total 35505.830400 599068.3300 16.8724
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Number of Children (Unduplicated) With at Least One Service 2425
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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 3 1.750000 64.7500 0.0000
P 1 1.000000 50.0000 50.0000
D 36 40.500000 2057.4500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 25 16.500000 206.2500 206.2500
46615 35446.080400 596689.8800 50.0000
Other 0 0.000000 0.0000 0.0000
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Total 46680 35505.830400 599068.3300 306.2500