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
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 650 258.000000 9546.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 717 681.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 883 2508.750000 92749.7500 36.9705
Subtotal (Total Children Is Unduplicated) 1687 3447.750000 102295.7500 29.6703
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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 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.500000 337.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 31 49.000000 2719.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 29 52.000000 3900.0000 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
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 99 206.500000 12637.8500 61.2002
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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 15 46.500000 2325.0000 50.0000
INTR-T1013-INTERPRETER 184 276.500000 13791.5000 49.8788
OCCT-97530-OT SESSION BY LICENSED OT 2 4.000000 285.7600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 8.000000 571.5200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 26.000000 1857.4400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 11.000000 152.6800 13.8800
Subtotal (Total Children Is Unduplicated) 303 561.250000 28058.9000 49.9936
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Total 4215.500000 142992.5000 33.9207
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Number of Children (Unduplicated) With at Least One Service 1815
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 2 1.750000 87.5000 0.0000
S 322 228.250000 9088.3400 0.0000
H 2 3.000000 171.4400 0.0000
T 0 0.000000 0.0000 0.0000
6180 3982.500000 133645.2200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6506 4215.500000 142992.5000 0.0000