CMS/EIP Fiscal Report Center: 53
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 951 1469.250000 54325.2500 36.9748
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 622 663.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1084 2713.250000 100112.7500 36.8977
Subtotal (Total Children Is Unduplicated) 1227 4845.500000 154438.0000 31.8725
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 10 12.750000 637.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 56.500000 4237.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 22.500000 1687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 37.000000 2775.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 161.000000 8907.7500 55.3276
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 111 200.000000 14962.5000 74.8125
SCREEN-T1023-SCREENING 5 6.000000 300.0000 50.0000
Subtotal (Total Children Is Unduplicated) 225 529.250000 35610.7500 67.2853
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 22.500000 1125.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 207 212.750000 10637.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 2.750000 68.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 92 65.750000 3287.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 9 4.250000 106.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 151 99.000000 4950.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 108 72.750000 3625.0000 49.8282
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.750000 18.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 593 1961.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 22.500000 562.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 252 1315.000000 65750.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 642 3311.000000 33110.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 38 171.000000 12202.0000 71.3567
PHY-97110-PT SESSION BY LICENSED PT 51 327.750000 23400.1800 71.3964
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 53 303.000000 21646.3200 71.4400
TRAV-TRAVS-Travel by mile 1 37.000000 16.4600 0.4449
Subtotal (Total Children Is Unduplicated) 648 7931.750000 180562.4600 22.7645
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Total 13306.500000 370611.2100 27.8519
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Number of Children (Unduplicated) With at Least One Service 1285
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Center 53
Flag Claims Units Chgs Paid
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R 6 6.000000 325.3200 0.0000
U 0 0.000000 0.0000 0.0000
B 2318 2144.110000 102468.7300 186.5000
P 1670 1537.630000 70696.5100 71614.3900
D 63 63.250000 3731.3300 0.0000
S 3 2.250000 9.2500 0.0000
H 43 42.750000 3054.0600 0.0000
T 0 0.000000 0.0000 0.0000
12156 9352.760000 181103.0700 0.0000
Other 167 157.750000 9222.9400 0.0000
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Total 16426 13306.500000 370611.2100 71800.8900