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
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 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 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 25 40.500000 2025.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 16.500000 1237.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 32 79.000000 5925.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 57.000000 4275.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 24.500000 1837.5000 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 159 238.500000 13236.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 243 407.500000 30562.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 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-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 422 931.000000 63600.5000 68.3142
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 60 80.000000 4000.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 28 38.750000 1887.5000 48.7097
CONIP-CONIP-CONSULT, ITDS PHONE 8 10.500000 262.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 31.250000 1562.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 33 46.750000 2337.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 2.750000 68.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 26 35.250000 1762.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 12.000000 300.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 144 610.250000 30512.5000 50.0000
INTR-T1013-INTERPRETER 248 289.500000 14426.2500 49.8316
OCCT-97530-OT SESSION BY LICENSED OT 34 188.250000 13448.5800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 2 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 59 347.750000 24843.2600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 6 16.000000 914.5600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 68 326.250000 23307.3000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 7 29.000000 402.5200 13.8800
Subtotal (Total Children Is Unduplicated) 553 2071.500000 120346.2700 58.0962
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Total 11579.750000 476348.5200 41.1363
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Number of Children (Unduplicated) With at Least One Service 2556
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2443 1794.250000 77780.2300 0.0000
H 6872 5072.000000 221389.2300 198557.6000
T 0 0.000000 0.0000 0.0000
6645 4512.750000 162878.2600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 16161 11579.750000 476348.5200 198557.6000