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
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 1825 4315.250000 159664.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 663 633.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 864 3329.750000 123200.7500 37.0000
Subtotal (Total Children Is Unduplicated) 2058 8278.250000 282865.0000 34.1697
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 118 234.000000 11700.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 36.000000 2700.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.000000 825.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 25.500000 1912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 35.500000 1970.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 20.500000 1537.5000 75.0000
Subtotal (Total Children Is Unduplicated) 186 369.500000 21092.2500 57.0832
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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 32 107.000000 5350.0000 50.0000
INTR-T1013-INTERPRETER 85 199.500000 9975.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 6.000000 428.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 29.000000 2071.7600 71.4400
Subtotal (Total Children Is Unduplicated) 329 739.500000 21181.6500 28.6432
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Total 9387.250000 325138.9000 34.6362
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Number of Children (Unduplicated) With at Least One Service 2107
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Center 09
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 10859 9332.500000 323388.6500 323388.6500
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
67 54.750000 1750.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10926 9387.250000 325138.9000 323388.6500