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
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 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
EXIT-EXIT-EXIT ASSESSMENT 44 67.000000 3350.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 12.500000 937.5000 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 34 89.000000 6675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 25.500000 1415.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 31.500000 2362.5000 75.0000
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 156 234.500000 13014.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 252 434.500000 32587.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
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 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 443 974.000000 66014.4400 67.7766
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 50 63.000000 3150.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 22 33.250000 1662.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 4.500000 112.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 22.750000 1137.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 25 30.500000 1525.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 24.250000 1212.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 5.500000 137.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 158 748.750000 37437.5000 50.0000
INTR-T1013-INTERPRETER 184 276.500000 13791.5000 49.8788
OCCT-97530-OT SESSION BY LICENSED OT 33 202.750000 14484.4600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 2 9.750000 557.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 57 275.000000 19646.0000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 6 22.000000 1257.5200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 67 288.750000 20570.7400 71.2407
SPL-92508-GROUP SPL SESSION PER CHILD 8 41.000000 569.0800 13.8800
Subtotal (Total Children Is Unduplicated) 501 2053.750000 117389.5000 57.1586
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Total 11674.250000 477997.9400 40.9446
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Number of Children (Unduplicated) With at Least One Service 2701
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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 4 3.000000 111.0000 111.0000
D 5 4.750000 258.9400 0.0000
S 3959 2991.250000 136640.3600 0.0000
H 6102 4344.500000 187467.1500 162623.6300
T 1 0.500000 18.5000 0.0000
6328 4120.750000 141377.1400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 16596 11674.250000 477997.9400 162734.6300