CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 547 281.500000 10415.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 696 674.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2504 7621.250000 281986.2500 37.0000
Subtotal (Total Children Is Unduplicated) 2526 8577.250000 292401.7500 34.0904
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 9.000000 436.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 182 357.250000 17562.5000 49.1603
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 22.000000 1650.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 34 82.500000 6187.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 13.500000 749.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 176 273.500000 20092.4300 73.4641
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 25.500000 1912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 42.500000 3187.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 393 625.000000 34586.6900 55.3387
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 295 507.000000 38025.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 10.5500 10.5500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 716 1978.750000 125421.4200 63.3842
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 5.000000 2503.8400 500.7680
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 228 312.500000 15437.5000 49.4000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 7.500000 168.7500 22.5000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 89 153.000000 7550.0000 49.3464
CONIP-CONIP-CONSULT, ITDS PHONE 19 26.000000 637.5000 24.5192
CONOF-CONOF-CONSULT, OT, FACE TO FACE 39 54.250000 2712.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 3.500000 68.7500 19.6429
CONPF-CONPF-CONSULT, PT, FACE TO FACE 46 90.750000 3037.5000 33.4711
CONPP-CONPP-CONSULT, PT, PHONE 3 2.750000 68.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 63 97.000000 4850.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 13 14.000000 350.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 585 3360.500000 167946.4400 49.9766
INTR-T1013-INTERPRETER 327 653.000000 32113.7500 49.1788
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1579 11415.00000 113997.0800 9.9866
OCCT-97530-OT SESSION BY LICENSED OT 55 345.750000 24230.3300 70.0805
OCCT-97530HM-OT SESSION BY OT ASST 2 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 87 494.750000 33961.4400 68.6436
PHY-97110HM-PT SESSION BY PT ASST 6 16.000000 914.5600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 143 753.500000 49312.7800 65.4450
SPL-92508-GROUP SPL SESSION PER CHILD 7 29.000000 402.5200 13.8800
TRAV-TRAVS-Travel by mile 989 78304.00000 33209.1000 0.4241
Subtotal (Total Children Is Unduplicated) 1944 96141.75000 493701.8900 5.1351
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Total 106697.750000 911525.0600 8.5431
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Number of Children (Unduplicated) With at Least One Service 2692
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Center 01
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 201 200.750000 14300.8000 0.0000
P 21252 90795.250000 372363.8100 372363.8100
D 254 846.500000 7908.5000 0.0000
S 2727 3519.750000 86273.2500 0.0000
H 6872 5072.000000 221389.2300 198557.6000
T 463 1204.750000 12191.5100 12191.5100
6673 4568.250000 165702.2100 0.0000
Other 305 490.500000 31395.7500 0.0000
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Total 38747 106697.750000 911525.0600 583112.9200