CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1614 1026.500000 37980.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 908 671.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2162 5446.250000 201511.2500 37.0000
Subtotal (Total Children Is Unduplicated) 2307 7143.750000 239491.7500 33.5247
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 38 73.500000 3675.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.500000 712.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 386 589.500000 44212.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 126 194.500000 14587.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 161 242.500000 18187.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 362 573.000000 31801.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 563 1696.500000 114012.0000 67.2042
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 118 119.250000 5850.0000 49.0566
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 8.750000 218.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 6.500000 325.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 13 16.000000 400.0000 25.0000
CONOP-CONOP-CONSULT, OT, PHONE 4 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 7.500000 375.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 8 10.500000 262.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1107 8195.000000 408710.0000 49.8731
INTR-T1013-INTERPRETER 2 12.000000 875.5000 72.9583
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1357 10899.00000 108850.0000 9.9872
OCCT-97530-OT SESSION BY LICENSED OT 90 288.500000 20466.3700 70.9406
OCCT-97530HM-OT SESSION BY OT ASST 32 99.500000 5656.5000 56.8492
PHY-97110-PT SESSION BY LICENSED PT 74 294.750000 20003.9600 67.8675
PHY-97110HM-PT SESSION BY PT ASST 4 7.000000 400.1200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 215 1022.000000 69911.9400 68.4070
SPL-92508-GROUP SPL SESSION PER CHILD 3 7.500000 83.2800 11.1040
Subtotal (Total Children Is Unduplicated) 1384 20998.75000 642538.9200 30.5989
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Total 29839.000000 996042.6700 33.3806
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Number of Children (Unduplicated) With at Least One Service 2488
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Center 06
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 11256 10752.500000 237634.4700 237634.4700
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
24202 19086.500000 758408.2000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 35458 29839.000000 996042.6700 237634.4700