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
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 811 575.750000 21302.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 715 744.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 439 1378.500000 50912.0000 36.9329
Subtotal (Total Children Is Unduplicated) 1226 2699.000000 72214.7500 26.7561
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 17.000000 824.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 20 28.750000 1437.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 23.500000 1762.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.500000 637.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.000000 388.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 22.500000 1687.5000 75.0000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 71 120.250000 7663.0000 63.7256
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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 2198.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 74.000000 3700.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 855 3994.000000 39920.0000 9.9950
OCCT-97530-OT SESSION BY LICENSED OT 17 65.250000 4661.4600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 13 89.000000 6358.1600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 132.250000 9447.9400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 864 7203.750000 96311.7600 13.3697
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Total 10023.000000 176189.5100 17.5785
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Number of Children (Unduplicated) With at Least One Service 1326
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Center 54
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 1 0.250000 0.0000 27.7500
D 11 9.250000 502.6500 0.0000
S 2 2.000000 10.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
13646 10011.500000 175676.8600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13660 10023.000000 176189.5100 27.7500