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
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 951 1469.250000 54325.2500 36.9748
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 622 663.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 298 715.000000 26418.0000 36.9483
Subtotal (Total Children Is Unduplicated) 1110 2847.250000 80743.2500 28.3583
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 9 10.750000 537.5000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.500000 582.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 21.000000 1575.0000 75.0000
SCREEN-T1023-SCREENING 4 5.000000 250.0000 50.0000
Subtotal (Total Children Is Unduplicated) 34 59.250000 3845.2500 64.8987
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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 1960.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 69.000000 3450.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 642 3310.000000 33100.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 5.000000 357.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 3.000000 214.3200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 20.000000 1428.8000 71.4400
TRAV-TRAVS-Travel by mile 1 37.000000 16.4600 0.4449
Subtotal (Total Children Is Unduplicated) 647 5891.250000 62541.7800 10.6160
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Total 8797.750000 147130.2800 16.7236
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Number of Children (Unduplicated) With at Least One Service 1206
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Center 53
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 3 3.000000 77.7500 96.2500
D 7 6.500000 240.5000 0.0000
S 2 2.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11607 8786.250000 146812.0300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11619 8797.750000 147130.2800 96.2500