CMS/EIP Fiscal Report Center: 57
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
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 415 184.250000 6817.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 218 163.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1551 6159.500000 227901.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1572 6507.500000 234718.7500 36.0690
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 110 160.500000 8025.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 26.000000 1950.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 35.500000 1970.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 229 248.000000 18600.0000 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 93 112.000000 8400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 319 384.500000 21339.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 32 36.000000 1837.8000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 31 32.000000 1633.6000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 55 57.000000 2909.8500 51.0500
Subtotal (Total Children Is Unduplicated) 531 1104.500000 67617.3000 61.2198
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 3.000000 150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 94 94.000000 4700.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 200 200.000000 10000.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 23 826.000000 20650.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1364 10857.00000 542850.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1373 11346.00000 113460.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 66 352.000000 25146.8800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 52 224.250000 12827.1000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 49 237.750000 16984.8600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 46 246.000000 14061.3600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 347.500000 24825.4000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 56 278.250000 15747.3000 56.5941
TRAV-TRAVS-Travel by mile 37 10706.00000 4764.0300 0.4450
Subtotal (Total Children Is Unduplicated) 1464 35719.75000 806266.9300 22.5720
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Total 43331.750000 1108602.9800 25.5841
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Number of Children (Unduplicated) With at Least One Service 1781
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Center 57
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 199 237.250000 10062.7500 0.0000
P 3617 4081.250000 165044.7300 161524.2600
D 0 0.000000 0.0000 0.0000
S 183 92.500000 6567.4200 6567.4200
H 0 0.000000 0.0000 0.0000
T 5235 26896.500000 364985.1400 364985.1500
5960 11975.250000 560744.3400 436612.4300
Other 31 49.000000 1198.6000 1198.6000
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Total 15225 43331.750000 1108602.9800 970887.8600