CMS/EIP Fiscal Report Center: 54
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 811 577.000000 21349.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 716 745.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1522 4856.750000 179413.0000 36.9410
Subtotal (Total Children Is Unduplicated) 1568 6179.000000 200762.0000 32.4910
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 17.000000 824.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 22 31.750000 1587.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 31.500000 2362.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 13.000000 975.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 21.500000 1612.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 129 212.500000 15900.0000 74.8235
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 59 87.500000 6562.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 31.000000 2325.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 31 47.500000 2636.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 94.500000 7087.5000 75.0000
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 313 602.250000 42642.5000 70.8053
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 79 95.250000 4733.9400 49.7002
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 352 173.000000 8625.0000 49.8555
CONIP-CONIP-CONSULT, ITDS PHONE 2 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 329 147.000000 7337.5000 49.9150
CONOP-CONOP-CONSULT, OT, PHONE 4 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 213 109.750000 5475.0000 49.8861
CONPP-CONPP-CONSULT, PT, PHONE 4 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 158 117.000000 5850.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 16 4.000000 100.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 763 2200.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 120 533.000000 26650.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 855 3994.000000 39920.0000 9.9950
OCCT-97530-OT SESSION BY LICENSED OT 97 529.750000 37831.1000 71.4131
PHY-97110-PT SESSION BY LICENSED PT 92 500.750000 35827.1600 71.5470
PHY-97110HM-PT SESSION BY PT ASST 5 5.000000 285.8000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 113 627.250000 44810.7400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.000000 41.6400 13.8800
Subtotal (Total Children Is Unduplicated) 864 9042.250000 217562.8800 24.0607
-----------------------------------------------------------------------------------------------------------------------
Total 15823.500000 460967.3800 29.1318
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1584
-----------------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 106 99.250000 4119.9700 0.0000
U 0 0.000000 0.0000 0.0000
B 2939 2487.000000 119424.4300 108.4400
P 2914 2401.330000 106892.2000 106307.6300
D 104 101.750000 6818.0700 0.0000
S 2 2.000000 10.0000 0.0000
H 38 37.000000 2621.8400 37.0000
T 0 0.000000 0.0000 0.0000
14149 10544.920000 212159.1600 0.0000
Other 169 150.250000 8921.7100 27.7500
---------------------------------------------------------
Total 20421 15823.500000 460967.3800 106480.8200