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
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 547 281.500000 10415.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 696 674.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 844 2442.000000 90354.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1599 3398.000000 100769.5000 29.6555
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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 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 14.000000 1050.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 23.000000 1725.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 64.000000 3552.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 50 94.500000 7087.5000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 118 255.500000 16755.7500 65.5802
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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 9 27.250000 1362.5000 50.0000
INTR-T1013-INTERPRETER 248 289.500000 14426.2500 49.8316
OCCT-97530-OT SESSION BY LICENSED OT 2 6.000000 428.6400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 5 23.500000 1678.8400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 34.000000 2428.9600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 9.000000 124.9200 13.8800
Subtotal (Total Children Is Unduplicated) 389 649.750000 32712.6100 50.3465
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Total 4303.250000 150237.8600 34.9126
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Number of Children (Unduplicated) With at Least One Service 1757
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 52 25.250000 937.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6408 4278.000000 149300.3600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6460 4303.250000 150237.8600 0.0000