CMS/EIP Fiscal Report Center: 03
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 791 519.500000 19221.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 425 460.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 495 1164.250000 43077.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1115 2144.500000 62298.7500 29.0505
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 75 94.750000 4737.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 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 8 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 94.000000 7050.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 17.000000 1275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 20.000000 1500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 73.000000 4051.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 23.500000 1762.5000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 87 97.000000 4850.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 227 453.750000 27455.8000 60.5087
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 57.500000 2875.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 85 108.500000 5425.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 40 50.250000 2512.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 24 34.500000 1725.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 132 181.500000 9075.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 245 272.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 38.750000 1937.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 39.000000 2771.9200 71.0749
OCCT-97530HM-OT SESSION BY OT ASST 3 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 13 44.000000 3143.3600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 45.000000 3214.8000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 47 139.000000 61.1700 0.4401
Subtotal (Total Children Is Unduplicated) 289 1016.000000 33002.6800 32.4830
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Total 3614.250000 122757.2300 33.9648
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Number of Children (Unduplicated) With at Least One Service 1229
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Center 03
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 0 0.000000 0.0000 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
5611 3614.250000 122757.2300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5611 3614.250000 122757.2300 0.0000