CMS/EIP Fiscal Report Center: 05
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 345 144.250000 5337.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 386 361.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1087 2536.000000 93832.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1120 3041.250000 99169.2500 32.6081
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 83.000000 6225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 9.000000 499.5000 55.5000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 63 99.500000 7189.1000 72.2523
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 4.000000 200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 3.500000 175.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 10.000000 250.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 27.500000 1375.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12 29.000000 290.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 2 13.000000 928.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 14.000000 1000.1600 71.4400
TRAV-TRAVS-Travel by mile 12 598.000000 266.0500 0.4449
Subtotal (Total Children Is Unduplicated) 25 700.500000 4547.4300 6.4917
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Total 3841.250000 110905.7800 28.8723
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Number of Children (Unduplicated) With at Least One Service 1121
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Center 05
Flag Claims Units Chgs Paid
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R 15 11.250000 501.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2311 1502.000000 57935.7500 41575.2400
P 101 693.000000 6046.0800 6046.0800
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
2709 1635.000000 46422.9500 43.4500
Other 0 0.000000 0.0000 0.0000
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Total 5136 3841.250000 110905.7800 47664.7700