CMS/EIP Fiscal Report Center: 09
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 1825 4315.250000 159664.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 737 684.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2073 7670.750000 283817.7500 37.0000
Subtotal (Total Children Is Unduplicated) 2274 12670.00000 443482.0000 35.0025
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 118 234.000000 11700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 17.500000 1267.5000 72.4286
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 325.0000 65.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 28.000000 1554.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 160 244.000000 17880.0000 73.2787
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 91 154.500000 11472.5000 74.2557
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 62 98.500000 7202.5000 73.1218
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 250 437.500000 23918.8000 54.6715
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 78 128.500000 8995.0000 70.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 138.1500 46.0500
Subtotal (Total Children Is Unduplicated) 602 1378.500000 86529.5000 62.7708
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 35 47.250000 2362.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 3.500000 87.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 9.000000 450.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 4.000000 200.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 246 329.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 89 281.250000 14062.5000 50.0000
INTR-T1013-INTERPRETER 85 199.500000 9975.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 57.000000 4072.0800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 222.250000 13897.5700 62.5312
Subtotal (Total Children Is Unduplicated) 334 1158.000000 45363.4000 39.1739
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Total 15206.500000 575374.9000 37.8374
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Number of Children (Unduplicated) With at Least One Service 2307
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Center 09
Flag Claims Units Chgs Paid
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R 2 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 332 357.000000 14796.2500 0.0000
P 15511 14412.500000 539175.9800 542957.6600
D 4 4.000000 285.7600 0.0000
S 0 0.000000 0.0000 0.0000
H 214 316.250000 15716.2500 0.0000
T 4 7.000000 404.4400 505.6900
112 108.250000 4940.7200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 16179 15206.500000 575374.9000 543463.3500