CMS/EIP Fiscal Report Center: 55
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
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 1057 1242.250000 45963.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 336 276.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 351 1259.250000 46592.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1126 2778.250000 92555.5000 33.3143
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 23 38.000000 1900.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 45 58.000000 2900.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.636800 422.7600 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 43.253868 3244.0400 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 35.430404 2657.2801 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.000000 1221.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 2.510284 128.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 2.174535 111.0100 51.0500
Subtotal (Total Children Is Unduplicated) 120 221.005891 13496.8901 61.0703
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 6.000000 300.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 84 89.500000 4475.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 116 129.750000 3243.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 35 50.000000 2500.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 50 85.000000 2125.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.500000 75.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 77 83.000000 4150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 98 91.500000 2287.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 24.000000 600.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 131 812.920000 40646.0000 50.0000
INTR-T1013-INTERPRETER 1 5.000000 312.0000 62.4000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 783 6179.000000 61790.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 126.967657 9070.5700 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 18 75.850700 4338.6600 57.2000
PHY-97110-PT SESSION BY LICENSED PT 12 72.033035 5146.0400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 10 30.676529 1753.4700 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 49 256.027446 18290.6000 71.4400
TRAV-TRAVS-Travel by mile 178 10526.00000 4682.9800 0.4449
Subtotal (Total Children Is Unduplicated) 824 18644.72537 165786.5700 8.8919
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Total 21643.981258 271838.9601 12.5596
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Number of Children (Unduplicated) With at Least One Service 1202
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Center 55
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 1 0.250000 9.2500 0.0000
P 7485 15660.999587 135666.1001 135666.1000
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
6503 5982.731671 136163.6100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13989 21643.981258 271838.9601 135666.1000