CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
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 650 258.000000 9546.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 717 681.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2644 7707.500000 285048.0000 36.9832
Subtotal (Total Children Is Unduplicated) 2677 8646.500000 294594.0000 34.0709
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 10 10.000000 485.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 241 453.750000 22475.0000 49.5317
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 22.000000 1650.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 35 91.000000 6825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 30.500000 1692.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 169 246.500000 17991.1200 72.9863
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 22.500000 1687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 39.000000 2925.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 371 594.500000 32994.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 288 532.000000 39759.0700 74.7351
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 80.6100 40.3050
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 776 2066.750000 129880.4900 62.8429
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 103.0600 103.0600
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 59.0000 59.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 228 321.750000 15662.5000 48.6791
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 94 150.500000 7475.0000 49.6678
CONIP-CONIP-CONSULT, ITDS PHONE 7 6.500000 156.2500 24.0385
CONOF-CONOF-CONSULT, OT, FACE TO FACE 29 39.750000 1987.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 40 47.500000 2375.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 69 93.250000 4662.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 9 6.750000 168.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 592 3639.000000 181775.0000 49.9519
INTR-T1013-INTERPRETER 257 718.000000 35365.7500 49.2559
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1547 12088.00000 120573.5400 9.9746
OCCT-97530-OT SESSION BY LICENSED OT 64 423.000000 28987.0100 68.5272
OCCT-97530HM-OT SESSION BY OT ASST 2 9.750000 557.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 83 436.750000 29205.6100 66.8703
PHY-97110HM-PT SESSION BY PT ASST 6 22.000000 1257.5200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 158 784.750000 50724.3600 64.6376
SPL-92508-GROUP SPL SESSION PER CHILD 8 41.000000 569.0800 13.8800
TRAV-TRAVS-Travel by mile 946 78575.00000 33173.3300 0.4222
Subtotal (Total Children Is Unduplicated) 1888 97413.50000 515094.7100 5.2877
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Total 108126.750000 939569.2000 8.6895
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Number of Children (Unduplicated) With at Least One Service 2827
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Center 01
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 197 209.500000 12124.8500 0.0000
P 21722 90551.750000 390446.9100 390262.5900
D 448 1492.000000 11676.2100 0.0000
S 4319 4407.000000 151840.4000 0.0000
H 6102 4344.500000 187467.1500 162623.6300
T 903 2556.750000 18903.7100 18885.2100
6345 4188.750000 142723.7200 0.0000
Other 256 376.500000 24386.2500 0.0000
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Total 40292 108126.750000 939569.2000 571771.4300