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:TPIN
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 1 2.750000 101.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 2.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 24 68.250000 2525.2500 37.0000
Subtotal (Total Children Is Unduplicated) 24 73.500000 2627.0000 35.7415
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 2.000000 97.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 25.500033 1912.5025 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 23.000000 1725.0000 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 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 491.2500 54.5833
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 69.000000 5175.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 37.500000 2812.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 32.000000 2400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 108 189.576304 10493.7350 55.3536
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 68 124.500000 9375.0000 75.3012
Subtotal (Total Children Is Unduplicated) 167 520.576337 35094.4875 67.4147
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 21.000000 1539.7200 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 1.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 12.250000 306.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 142 1443.918640 72170.9320 49.9827
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 77.000000 5422.3200 70.4197
PHY-97110-PT SESSION BY LICENSED PT 20 221.000000 15791.8200 71.4562
PHY-97110HM-PT SESSION BY PT ASST 3 5.000000 285.8000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 280.250000 20017.4800 71.4272
SPL-92508-GROUP SPL SESSION PER CHILD 7 8.250000 114.5100 13.8800
Subtotal (Total Children Is Unduplicated) 184 2072.168640 115708.8320 55.8395
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Total 2666.244977 153430.3195 57.5455
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Number of Children (Unduplicated) With at Least One Service 269
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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 247 194.193300 10133.7151 12687.4400
D 111 110.579585 5955.9000 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
1325 1342.972092 74307.0444 0.0000
Other 928 1018.500000 63033.6600 0.0000
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Total 2611 2666.244977 153430.3195 12687.4400